Apply for Experienced CAREGivers

Become a Care Professional >> Experienced CAREGivers >> Apply

Hello and thank you for your interest in Home Instead. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 11 Gamecock Ave., Suite 1105, Charleston, SC 29407. Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at 843-571-3000.

Summary
Title:	Experienced CAREGivers
ID:	1517
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
Home Phone:
Cell Phone:
* Email:
Opt-In Confirmation
	I authorize recruiters from Home Instead 264 to send text messages from 8444512535 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.

Additional Information

* How did you hear about Home Instead?

If applicable, please specify:

US CAREGiver Employment Application

APPLICANT NOTE

If you are considered for a position, we may contact your references and would ask that you notify them in advance. Please do not list relatives or family/relations.

INSTRUCTIONS: If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

Please read "Applicant Note" below.
Complete all parts of this application.
Application will be valid for 60 days.

Applicant Note: This application form is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body is required prior to employment.

PERSONAL INFORMATION

Other Names Previously Used:

	Last Name	First Name	Middle Name
1.
2.

* Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?

Yes No

* Are you at least 18 years or older?

Yes No

AVAILABILITY

Due to the nature of the business, no guarantee can be made as to the schedule or the amount of hours worked.

* What date are you available to begin work?

Please Complete all Areas of Availability.

Please fill out the availability chart below. We use this schedule to be able to staff you on shifts that fit your specified availability. During orientation, you will receive at least your first month schedule based upon this chart. It is crucial to making our business run smoothly that you adhere to the schedule you gave us. To be eligible to receive 30-40 hours a week you must be available to work a minimum of 2 weekends a month.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

I am happy to work:

With Cats

Yes No

With Dogs

Yes No

With Smokers

Yes No

WORK HISTORY

MOST RECENT EMPLOYER

Are you currently working for this employer?

Yes No

Company Name:

City:

State:

Dates Employed - From:

Dates Employed - To:

Job Title:

Duties:

Salary:

Per Hour/Week/Month:

Reason for Leaving:

SECOND MOST RECENT EMPLOYER

Are you currently working for this employer?

Yes No

Company Name:

City:

State:

Dates Employed - From:

Dates Employed - To:

Job Title:

Duties:

Salary:

Per Hour/Week/Month:

Reason for Leaving:

BACKGROUND

As a condition of employment, all employees must be "Bondable".

List states and counties of residence for the past seven (7) years:

County:

State:

County:

State:

County:

State:

County:

State:

* Have you had any moving traffic violations?

Yes No

If yes, please describe:

* Have you ever been convicted of a felony or misdemeanor?

Yes No

If Yes, please describe below:
(Conviction will not necessarily disqualify applicant from employment. The recency, severity, and pertinence of the conviction to the job will all be considered.)

Incident	City/State	Result

CERTIFICATION AND RELEASE

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT FOR EMPLOYMENT

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

U.S. Release & Authorization for Criminal Background Check & Drug Screen

Release Authorization

* Last Name:	* First Name:	Middle Initial:
Maiden/Previous Names:
* Home Address:	* City:
* State:	* Zip Code:
* Social Security Number:	* Date of Birth:
* Driver's License Number:	* Issuing State:	* Issue Date:

Authorization to Secure Consumer Investigative Report

I authorize Companion Management, LLC, d.b.a. an independently owned and operated Home Instead franchise, to make whatever inquiries it may deem necessary in connection with my course of employment. As part of such inquiries, Employer has my permission to contact persons who may have information regarding my suitability for employment and to secure consumer reports (including investigative consumer reports).

I authorize and instruct any person or agency contacted to participate or conduct inquiries at its request, to compile information, and to furnish any information obtained as a result of such inquiries.

I further authorize Employer, in its sole discretion, to furnish copies of this authorization and my application to any person and/or consumer-reporting agency in connection with above purposes.

Authorization for Drug Screening

I consent to drug testing designed to detect the presence of alcohol or the illegal use of drugs.

Disclosure Statement

Information contained in reports obtained by Employer in accordance with above authorization may include information pertaining to your character, general reputation, police record, personal characteristics, and mode of living. You have the right to request that Employer completely and accurately disclose to you the nature and scope of all investigations requested. Such a request must be made in writing within a reasonable period of time after your application for employment is received.

I hereby acknowledge that I have read and understand the above disclosure statement.

* Signature (type name):

* Date:

Additional Questions

Please answer each question and check all that apply.

Please describe any previous experience you have as a Care Giver. This could be on a professional level or care that was provided for a family member or friend.

* As you may be required to transport a client during the course of a shift, do you have your own reliable, personal vehicle and can you provide this service?:

Yes No

* Do you have car insurance in your name or with your name listed on the policy?

	Yes
	No

* One of the essential functions of the role as CAREGiver is to lift, push, or pull 25 pounds. Are you able to do this?:

Yes No

* Although it is not a requirement, are you currently or have you previously worked as a licensed CNA or Medical Assistant?

	Yes
	No

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