Apply for Certified Caregiver Position for our Care Team

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Certified Caregiver Position for our Care Team
ID:1001
Location:Tucson, AZ
Hourly Range:$20+
Resume
Resume:
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Caregiver Questionnaire
* Are you a certified caregiver in the state of Arizona?
Yes
No
I am currently in Caregiving School for my certificate
* Do you have a valid Fingerprint Clearance Card?
Yes
No
* Do you have a current First Aid/ CPR Certificate?
Yes
No
* Do you have a current negative Tuberculosis test?
Yes
No
How do you plan on getting to work?
I will drive myself
I will take the bus
I will walk
I will use uber / lift / taxi
* How long have you been a caregiver?
I do not have any experience
This is my first year
For at least 5 years
Above 5 years
* Are you able to work well with a team?
Yes
No
Application for Employment
PERSONAL INFORMATION
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
CAREGIVER EDUCATION & EXPERIENCE
Yes   No
EMPLOYMENT DESIRED
Full Time   Part Time   Seasonal
Yes   No
Yes   No
PERSONAL REFERENCES

Please give the names & phone numbers of three people who you have not worked for & who are not relatives.

Reference 1

Reference 2

Reference 3
EMPLOYMENT HISTORY

List below your last 3 employers, starting with the most recent.

Employer 1

Yes   No

Employer 2

Yes   No

Employer 3

Yes   No

Employer 4

Yes   No

Employer 5

Yes   No
SHIFT AVAILABILITY

Select all shifts you are available to work. If you mark nights, please be aware that these are not monitor shifts, but that you must be awake & working throughout the shift. Flexibility is a virtue. You may be called upon to work any of the shifts you mark here. Overtime hours are sometimes required.

  
  
  
  
  
  
  
  
  
  
  
  
  
  
NON-COMPETITION AGREEMENT

I hereby agree that during my employment with this company, & for six (6) months after my employment with the company is terminated, I will not contact or try to persuade any resident, or the family of any resident, to move themselves or their family member to any other adult care home or health care institution, or to put themselves privately into my care. Further, I will not care for such a person in my own home, their home or another assisted living facility. I acknowledge that such activity would jeopardize the company’s relationship with its clients. I acknowledge that the company’s relationship with its clients is a valuable asset of the company, the loss of which cannot be reasonable estimate. I further acknowledge that the company shall have the right to an injunction if I violate this paragraph, & I agree to an award of any attorney fees necessary for the company to enforce this paragraph.

JOB APPLICATION DISCLAIMER AND ACKNOWLEDGEMENT

I hereby assert that answers given on this application are true & complete to the best of my knowledge. I authorize the company to make such investigations & inquiries of my personal, employment, financial or medical history & other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, or persons from all liability in responding to inquiries in connection with my application. In the event I am hired, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules & regulations of the company & by all state & federal laws, rules & regulations concerning the operation of adult care homes.

Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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