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HomeStay LLC Application for Employment
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Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered.. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.
First Name M.I. Last Name
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Your answer
Today's Date
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MM
/
DD
/
YYYY
Email
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Your answer
Phone number
*
Your answer
Present Address (Including City State and Zip code)
*
Your answer
How did you hear about us?
Your answer
Which position(s) are you applying
*
Choose
HomeStay Home Aide
in-Home CNA
Desired Start Date
MM
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DD
/
YYYY
Are you seeking
Full-Time
Part-Time
Temporary
Seasonal
Clear selection
Are you 18 year of age or older? (if hired you may be required to submit proof of age)
Yes
No
Clear selection
Last four digits of Social Security Number
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
If hired, can you furnish proof you are eligible to work in the U.S.?
Yes
No
Clear selection
Have you ever applied to work at HomeStay?
Yes
No
Clear selection
If yes, when?
Your answer
Have you ever been employed by Homestay Home Care
Yes
No
Clear selection
If yes, when?
Your answer
Have you ever been convicted of any law violation (except a minor traffic violation)? A “Yes” answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will also be considered.)
*
Yes
No
If yes, give details:
Your answer
Are you now or do you expect to be engaged in any other business or employment?
Yes
No
Clear selection
If yes, please explain:
Your answer
Do you have a valid driver’s license?
Yes
No
Clear selection
Driver’s License Number State: Class of License
*
Your answer
Have you had your driver’s license suspended or revoked in the last 3 years?
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Yes
No
If yes, give details:
*
Your answer
List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal age over 40, race, sex, color, religion, national origin, disability or other protected status.)
*
Your answer
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