Personal Health Care

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Personal Details

Full Name*

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Email Address*

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Phone Number*

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Experience

Work History*

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Education*

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Experience Summary

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Cover Letter

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  • How many years of caregiver experience do you have?*

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  • Do you have a Driver's License?*

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  • Do you have your own vehicle for transportation?*

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  • How far are you willing to travel for work by car?*

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  • Are you willing to work with pediatric (under 18 years of age) clients?*

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  • What are your preferred pronouns?*

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  • What is your complete address? (Street address, City/Town, State, & Zip Code required)*

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  • What position are you applying for?*

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  • Are you looking for full time, part time, or per diem?*

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  • Have you previously applied to or been employed by Personal Health Care?*

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  • Do you smoke?*

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  • Are you allergic to or afraid of pets?*

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  • Most recent education/training:*

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  • Where did you receive your most recent education/training?*

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  • When did you receive your most recent education/training?*

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  • Are you CPR certificed?*

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  • What is your pay rate requirements/expectations?*

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  • Most recent employer (Company's name):*

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  • Position Held:*

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  • Supervisor's name:*

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  • Date's employed: (start and end date)*

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  • Phone number of most recent employer:*

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  • Employment Status:*

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  • What are/were your job responsibilities?*

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  • Previous employer: (Company's Name)*

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  • Position Held:*

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  • Supervisor's Name:*

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  • Dates Employed (start and end dates)*

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  • Employment Status:*

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  • What are/were your job responsibilities?*

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We're an equal opportunity employer

You are requested (not required) to complete the personal data below. This information will only be used for government reporting purposes and not as selection criteria for our hiring process.

  • Race or Ethnicity

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  • Gender

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