Elders' Helpers Employment Application
First Name *
Your answer
Last Name *
Your answer
Date *
MM
/
DD
/
YYYY
Home Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Email Address
Your answer
How did you hear about Elders' Helpers?
Your answer
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?
Your answer
If applying for temporary work, when will you be available?
MM
/
DD
/
YYYY
If hired, on what date can you start working?
MM
/
DD
/
YYYY
Are you available to work every weekend or every other weekend?
Can you work evenings?
PERSONAL INFORMATION
Have you ever applied to or worked for Elders' Helpers? *
If yes, please explain (include dates).
Your answer
Do you have any friends, relatives, or acquaintances working for Elders' Helpers?
If yes, state name(s) and relationship(s).
Your answer
If hired, would you have your own vehicle to travel to/from work?
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?
If hired, are you willing to submit to and pass a controlled substance test?
Are you able to perform the essential functions of the job for which you are applying?
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.
Your answer
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. *
Your answer
EDUCATION / TRAINING AND EXPERIENCE
High School Name
Your answer
School Address
Your answer
Did you graduate?
Number of years completed
Your answer
Degree / Diploma
Your answer
College / University / Trade or Business School Name
Your answer
College / University / Trade or Business School Name Address
Your answer
Did you graduate?
Number of years completed
Your answer
Degree / Diploma
Your answer
EMERGENCY NOTIFICATION
Name
Your answer
Phone Number
Your answer
PREVIOUS EMPLOYMENT EXPERIENCE
Employer name *
Your answer
Address *
Your answer
Length and dates of service *
Your answer
Job title *
Your answer
Reason for leaving *
Your answer
Employer name
Your answer
Address
Your answer
Length and dates of service
Your answer
Job title
Your answer
Reason for leaving
Your answer
Employer name
Your answer
Address
Your answer
Length and dates of service
Your answer
Job title
Your answer
Reason for leaving
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Elders Helpers.