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Captures education history with dates and credentials, requires listing and attaching documents such as licenses, CPR/First Aid, SSN card, TB test, permits, photo, and certifications. 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                   Last\nADDRESS: _____________________________________________________________\nStreet Address                                                                                                  Apt/Suite\n_____________________________________________________________\nCity                                                     State                                                      Zip Code\nE-MAIL: __________________________________ PHONE: _____________________\nSOCIAL SECURITY NUMBER (SSN): _____-____-_____    DATE AVAILABLE:\n__________________ DESIRED PAY: $_________\nPOSITION APPLIED FOR: _________________________________________________\nEMPLOYMENT ELIGIBILITY\nARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO\nHAVE YOU EVER WORKED FOR THIS COMPANY? ☐ YES ☐ NO\nIF YES, WRITE THE START AND END DATES:\nHAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES ☐ NO\nIF YES, PLEASE EXPLAIN:\nHOW MANY YEARS OF CAREGIVING EXPERIENCE DO YOU HAVE?\nTYPES OF CLIENTS YOU HAVE WORKED WITH (DEMENTIA/ALZHEIMER’S, FEEDING TUBE/ASSISTANCE, POST SURGICAL, HOSPICE, GAIT BELT, HOYER LIFT, Etc.)\nHOW MUCH WEIGHT CAN YOU LIFT?\nWHEN ARE YOU AVAILABLE TO WORK (HOURS PER DAY/ WEEKENDS/ NIGHTS (specify for each day)\nHOW DID YOU LEARN OF FAMILY BEST CARE?\nHAVE YOU EVER APPLIED OR WORKED AT FAMILY BEST CARE?\nIF YES, PROVIDE DATES:\nDO YOU HAVE A VALID DRIVER’S LICENSE AND/OR STATE VEHICLE INSURANCE?\nDO YOU HAVE RELIABLE TRANSPORTATION?\nARE YOU WILLING TO TRANSPORT CLIENTS IN YOUR VEHICLE OR THEIRS?\nEDUCATION\nHIGH SCHOOL: _____________________ CITY / STATE: _____________________\nFROM: _____________________ TO: _____________________\nGRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________\nCOLLEGE: _____________________ CITY / STATE: _____________________\nFROM: _____________________ TO: _____________________\nGRADUATE? ☐ YES ☐ NO DEGREE: _____________________\nOTHER: _____________________ CITY / STATE: _____________________\nFROM: _____________________ TO: _____________________\nDEGREE/CERTIFICATION: _____________________\nPLEASE PROVIDE A COPY OF THE FOLLOWING:\nCURRENT LICENSE (NAR, CAN or HOME HEALTH CARE AID)\nCURRENT CPR/ FIRST AID CARD\nSOCIAL SECURITY CARD\nANY CE COURSES COMPLETED\nCURRENT TB TEST RESULTS (must have been done within the last year)\nCURRENT FOOD HANDLERS PERMIT\nCOVID VACCINE CARD\nPASSPORT PHOTO\nDRIVER’S LICENSE\nOTHER CERTIFICATIONS (ex. Nurse delegation, 75 hours, diabetes special focus, e.t.c.)\nPREVIOUS EXPERIENCE\nEMPLOYER 1: __________________________________________________________\nCompany / Individual\nE-MAIL: __________________________________ PHONE: _____________________\nADDRESS: ____________________________________________________________\nStreet Address                                                                                                  Apt/Suite\n____________________________________________________________\nCity                                                     State                                                      Zip Code\nSTARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY\nJOB TITLE: ______________ RESPONSIBILITIES: _____________________________\nFROM: _____________________ TO: _____________________\nREASON FOR LEAVING: _______________________________________________________\nEMPLOYER 2: __________________________________________________________\nCompany / Individual\nE-MAIL: __________________________________ PHONE: _____________________\nADDRESS: ____________________________________________________________\nStreet Address                                                                                                  Apt/Suite\n____________________________________________________________\nCity                                                     State                                                      Zip Code\nSTARTING PAY: $_______","cbCaip9Xxrro3P6h","https://ap.wps.com/l/cbCaip9Xxrro3P6h","docx",57258,7,"English","# Personal Information\n## Employment Eligibility\n## Education\n## Previous Experience\n## References\n## Military Service","[{\"question\":\"What personal details and contact information are requested in this form?\",\"answer\":\"The form requests full name, address, email, phone number, social security number, date available, desired pay, and the position applied for.\"},{\"question\":\"What employment eligibility and caregiving questions must applicants answer?\",\"answer\":\"Applicants answer whether they are legally eligible to work in the U.S., whether they previously worked for the company, felony conviction history, years of caregiving experience, client types served, lifting ability, availability, transportation reliability, and willingness to transport clients.\"},{\"question\":\"Which supporting documents does the form request applicants to provide?\",\"answer\":\"The form lists items to attach or provide copies of, including current licenses (e.g., NAR/CAN/home health aide), CPR/First Aid card, social security card, CE course completion, recent TB test results, food handlers permit, COVID vaccine card, passport photo, driver’s license, and other certifications.\"}]","Employment / Job Application - Personal Information - Application Form Template | DOCX"]