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Application for Employment at Chosen Family Home Care

Thank you so much for considering Chosen Family Home Care as your next employer! We are thrilled that you are interested in joining the Chosen Family Home Care team. Chosen Family Home Care is an Equal Opportunity Employer and committed to excellence through diversity.

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

Contact Information:

First name*

Last name*

Address 1*

Address 2

City*

State*

Zip*

Cell Phone*

Email*

How did you hear about Chosen Family Home Care?

Are you legally eligible to work in the US?*
YesNo

If selected for employment are you willing to submit to a background check?*
YesNo

Position:

Position you are applying for*

Available start date

Desired pay

Employment desired
Full TimePart TimeSeasonal/Temporary

Education:

High School

School Name*

Location*

Did you graduate?*
YesNo

Year graduated

College (If applicable)

School Name

Location

Did you graduate?
YesNo

Year graduated

Degree received

References
All applicants must submit at least two references. References may be personal or professional, but cannot be family members.

Reference 1

Name*

Phone*

Email*

Relationship to reference*

Reference 2

Name*

Phone*

Email*

Relationship to reference*

Reference 3

Name

Phone

Email

Relationship to reference

Employment History
Applicants must list at least previous two years of employment history.

Employer 1

Company name*

Job Title*

Start date of employment*

End date of employment*

Ending pay rate*

Address*

City*

State*

Zip*

Employer 2

Company name

Job Title

Start date of employment

End date of employment

Ending pay rate

Address

City

State

Zip

Employer 3

Company name

Job Title

Start date of employment

End date of employment

Ending pay rate

Address

City

State

Zip

Have you lived in the state of Pennsylvania for the last two years continuously?
YesNo

Are you currently working with a client that you want to bring to the agency (switching home care agencies with your client to Chosen Family Home Care)? If yes, please provide more details.

How did you hear about us?*
Please select an optionIndeedGoogle SearchFacebookFlyer or PostcardStreet advertisementRadioNewspaperWord of MouthCurrent EmployeeCurrent ClientJob Fair/Community EventOther

* Candidate attestation: The facts set forth in this application are true and complete to the best of my knowledge. I understand that falsified statements on this application shall be considered sufficient cause for immediate discharge once employed. I hereby authorize investigation of all statements contained herein and release all parties from liability for confirming/denying the information provided.

I understand that neither this application nor any part of consideration for employment establishes an obligation for the company to hire me.

I attest that I am over 18 years of age and am legally eligible to work in the United States of America.

Please type your name to sign electronically*

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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