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Integrity Home Care: 315.468.1484

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Employment

JOIN OUR TEAM

ConstantCare247 is always looking for bright and talented individuals to be on our team and referral placement agency.

Please fill out the application below, and someone will reach out soon!

employment form

Personal Information

Date of Application

First Name

Last Name

Phone Number

Present Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Permanent Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Are you 18 years or older?

Yes

Do you have a valid driver's license?

Yes

Do you have reliable transportation?

Yes

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

Yes

Do you have any reservations about working around cats, dogs, or any other pets?

Yes

Employment Desired

Postion

Date you can start

Salary Desired

Are you employed now?

Yes

If so, may we inquire of your present employer?

Yes

Have you ever applied to this company before?

Yes

If Yes, where and when? (If no, simply type "n/a")

Referred By

Education

if anything does not apply to you, please type "n/a"

High School

Name of School:

Location:

No. of Years Attended:

Did you Graduate?

Yes

n/a

Subjects Studied:

College

Name of School:

Location:

No. of Years Attended:

Did you Graduate?

Yes

n/a

Subjects Studied:

Trade, Business, or Correspondence School

Name of School:

Location:

No. of Years Attended:

Did you Graduate?

Yes

n/a

Subjects Studied:

General

Subjects of Special Study or Research Work

Special Skills

Activities: (Civic, Athletic, Etc.)

Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members.

U.S. Military or Naval Service

Military Rank

Present Membership in National Guard or Reserves?

Yes

n/a

Work Availability

In order to help us cater to our client's needs, please be as specific as possible with your availability in the text areas below the checkboxes.

Monday

None

Hours

Tuesday

None

Hours

Wednesday

None

Hours

Thursday

None

Hours

Friday

None

Hours

Saturday

None

Hours

Sunday

None

Hours

Do you have any of the following certifications?

PCA

CNA

HNA

None

Other

If "Other", please tell us here:

If the need arises, are you able to transport clients in your personal vehicle?

Yes

Former Employers

List below last three employers, starting with the last one first.

if no previous experience, please type "n/a"

Employer 1

Employed from:

Employed to:

Name and Address of Employer

Position

Supervisor Name

Supervisor Phone Number

Reason for leaving:

Employer 2

Employed from:

Employed to:

Name and Address of Employer

Position

Supervisor Name

Supervisor Phone Number

Reason for leaving:

Employer 3

Employed from:

Employed to:

Name and Address of Employer

Position

Supervisor Name

Supervisor Phone Number

Reason for leaving:

Professional References

Give the names of three persons not related to you, whom you have known at least one year

Professional Reference 1

Name

Phone

Business

Years Acquainted

Professional Reference 2

Name

Phone

Business

Years Acquainted

Professional Reference 3

Name

Phone

Business

Years Acquainted

Emergency Contact Information

In case of emergency, notify

Address

Address Line 1

City

State

Zip Code

Phone Number

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in wrong and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."

Date

Check this box to confirm the above certification

I agree