Elders' Helpers Employment Application
First Name *
Last Name *
Date *
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DD
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Home Address *
City *
Zip Code *
Home Phone *
Cell Phone *
Email Address
How did you hear about Elders' Helpers?
Are you applying to work with a specific client? *
Which office location are you applying for? *
What position are you applying for? *
Required
Full-time work or part-time work? *
What days and hours are you available for work?
If applying for temporary work, when will you be available?
MM
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DD
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YYYY
If hired, on what date can you start working?
MM
/
DD
/
YYYY
Are you available to work every weekend or every other weekend?
Clear selection
Can you work evenings?
Clear selection
PERSONAL INFORMATION
Have you ever applied to or worked for Elders' Helpers? *
If yes, please explain (include dates).
Do you have any friends, relatives, or acquaintances working for Elders' Helpers?
Clear selection
If yes, state name(s) and relationship(s).
If hired, would you have your own vehicle to travel to/from work?
Clear selection
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?
Clear selection
If hired, are you willing to submit to and pass a controlled substance test?
Clear selection
Are you able to perform the essential functions of the job for which you are applying?
Clear selection
If no, please describe the functions that cannot be performed.
Note: A new hire will be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.
Have you ever been convicted of a criminal offense (felony or misdemeanor)? *
If yes, please describe the crime(s): state the nature of the crime(s), when and where convicted, and disposition of the case. If no, write "none" in space provided. *
EDUCATION / TRAINING AND EXPERIENCE
High School Name
School Address
Did you graduate?
Clear selection
Number of years completed
Degree / Diploma
College / University / Trade or Business School Name
College / University / Trade or Business School Name Address
Did you graduate?
Clear selection
Number of years completed
Degree / Diploma
EMERGENCY NOTIFICATION
Name
Phone Number
PREVIOUS EMPLOYMENT EXPERIENCE
Employer name *
Address *
Length and dates of service *
Job title *
Reason for leaving *
Employer name
Address
Length and dates of service
Job title
Reason for leaving
Employer name
Address
Length and dates of service
Job title
Reason for leaving
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