Comfort Keepers Employment Application

Carefully and accurately fill out all fields. When ready, click "Submit" below.
1. How long have you been at your current address?
2. How did you hear about Comfort Keepers?
3. What prompted you to call Comfort Keepers? Explain
4. Do you have expierence working as a caregiver? Explain
5. When are you available to start work?
6. How many hours per week are you willing to work?
7. How many miles are you willing to travel for work?
8. Are you currently employed?
Yes No
9. What days/hours are you available to work for Comfort Keepers?
10. What is the earliest start time in the AM you can be at a Client's Home?
11. What is the latest time at night you can stay with a client?
12. Are you available to do overnight stays?
Yes No
13. Are you available to do live in arrangements?
Yes No
14. Have you previously applied for a position at Comfort Keepers?
Yes No
15. Have you previously worked at Comfort Keepers?
Yes No
16. Are you eligible to work in the United States?
Yes No
17. Have you ever been convicted of or pleaded guilty to any criminal offense? (Conviction will not necessarily disqualify you)
Yes No
18. Do you have access to a safe, insured automobile for transporting clients?
Yes No
19. Do you have a valid driver's license?
Yes No
20. Any moving violations within the last 3 years?
Yes No
21. Do you have any relatives currently employed by Comfort Keepers?
22. Do you have a High School Diploma or GED?
Yes No
23. Are you currently a CNA, LPN, RN or HHA?
Yes No
24. Please list your previous employer. Include name, phone number and dates of employment
25. Plesae list your second to last employer. Include name, phone number and dates of employment
26. Please list your third to last employer. Include name, phone number and dates of employment.