Virginia Home Care Partners | EmployeesVirginia Home Care Partners

If you are human, leave this field blank.

First Name *

Last Name *

Email *

Address

Street Address

City

State

Zip Code

Cell Phone *

High School

City

State

Dates attended high school

Did you graduate high school?

Yes

Other Education

Type of License or Certification Currently Held (RN, LPN, CHHA, CNA, PCA, etc.)

Do you have a valid driver’s license?

Yes

Do you have your own reliable transportation and auto insurance?

Yes

Have you ever been convicted of a crime (felony or misdemeanor), including sex-related or child-abuse related offenses? *

Yes

If yes, please explain: *

What tickets do you have for motor vehicle violations - type and date?

Current / Most Recent Employer’s Name

Job Title

Employed From

Employed To

Reason for Leaving

Starting Wage

Ending Wage

Please describe your caregiving experience

Availability

How many hours per week do you prefer to work?

All staff are required to work four weekend days each month. Are you available for weekend work?

Yes

Please indicate specific times each day you would be available to work

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Can we assign you to a client who has a cat?

Yes

Can we assign you to a client who has a dog?

Yes

How did you hear of this position?

newspaper ad, friend, co-worker

APPLICANT’S AUTHORIZATION FOR RELEASE OF INFORMATION

Authorization

By checking here I agree to the above Authorization *

Agree

APPLICANT’S CERTIFICATION & AGREEMENT:

Certification

I certify that any and all statements that I have set forth in this application are true and correct to the best of my knowledge.  I understand that any omission or misrepresentation by me in this application are cause for possible cancellation of this application or, if employed, may be cause for dismissal, regardless of time of discovery.  Any offer of employment is contingent upon completion of a successful background investigation.  I further understand that if I am hired by Virginia Home Care Partners, I must agree, in writing, to comply with the Virginia Home Care Partners Employment Manual.  Any employment resulting from this application will be employment at will.  This means that an employee has the right to terminate their employment at any time for any reason, and the company may exercise the same right.All applicants for employment will be considered without regard to race, religion, color, national origin, sex, marital status, pregnancy status, age, disability, veteran status, sexual orientation, or sexual affectation.  I (Applicant) hereby authorize Virginia Home Care Partners to request and receive from all prior employers, within 3 years of the date of this application, any and all pertinent information concerning my prior employment and its termination, including the reasons for such termination.   I hereby release said companies, organizations, agents, individuals, and Virginia Home Care Partners from any liability for any damage whatsoever resulting from the giving of such information.

By checking here I agree to the above Certification and Agreement *

Agree

reCAPTCHA

Join Our Care Team

How May We Partner With You?

Our partnership with our staff is as important to us as our partnership with our clients! Our Care Partners are the key to providing trusted, compassionate care. We provide a caring, supportive, and professional environment for our Care Team members, treating them with dignity and respect.

We are always accepting employment applications for Care Partners. If you desire to join our committed partnership team and believe you offer dedication and passion for caregiving, we would love to hear from you.

Availability

APPLICANT’S AUTHORIZATION FOR RELEASE OF INFORMATION

APPLICANT’S CERTIFICATION & AGREEMENT: