Apply for CAREGiver

Hello and thank you for your interest in Home Instead Senior Care. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 1500 Oxford Drive, Suite 10, Bethel Park, PA 15102. Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at 412-595-7554. If you have any technical problems with this site please call 919-508-6147 for technical assistance.

Summary
Title:CAREGiver
ID:1029
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
Cell Phone:
Work Phone:
* Email:
* Social Security Number:
* Date of Birth:
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Additional Information
* How did you hear about Home Instead Senior Care?
If applicable, please specify:
CAREGiver Prescreen Questions
* Are you 18 years of age or older?
Yes
No
* Are you able to lift 25 pounds?
Yes
No
* Do you have reliable transportation?
Yes
No
US CAREGiver Employment Application
APPLICANT NOTE
Greater Pittsburgh Assisted Living Services, Inc is an independently owned and operated Home Instead Senior Care® franchise located at 1500 Oxford Drive, Suite 10, Bethel Park, PA 15102 Phone: (412) 595-7554

INSTRUCTIONS: If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.
  • Please read "Applicant Note" below.
  • Complete all parts of this application.
  • Application will be valid for 60 days.


Applicant Note: This application form is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead Senior Care franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body is required prior to employment.


PERSONAL INFORMATION
Previous Names, Maiden Names, and Aliases:
  Last Name First Name Middle Name
1.
2.


* Have you ever submitted an application here before?
Yes   No
If yes, when?
* Have you ever been employed here before?
Yes   No
If yes, when?
* Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?
Yes   No
* Do you have a reliable vehicle in order to travel to/from client home?
Yes   No
* Do you have current automobile insurance on this vehicle?
Yes   No
* Do you have a valid driver's license?
Yes   No

AVAILABILITY
* What date are you available to begin work?
Please Complete all Areas of Availability.
* Total hours preferred to work per week:
* Regular work availability (check all that apply):
Mornings (8 a.m. -12 p.m.)   Afternoons (12 p.m. – 5 p.m.)   Evenings (5 p.m. – 10 p.m.)   Overnight (10 p.m. – 8 a.m.)
* Days Available for work (check all that apply):
Sunday   Monday   Tuesday   Wednesday   Thursday   Friday   Saturday
* Are you able to commit to working at least 1 evening per week?
Yes   No
* Are you able to commit to working at least 1 weekend per month?
Yes   No
* Are you able to commit to working 4 holidays per calendar year?
Yes   No
* Are you currently a Student?
Yes   No
Please list any additional comments about your work availability here:

CAREGIVING EXPERIENCE

* Do you have any experience as a CAREGiver?
Yes   No
If yes, is your experience personal or professional?
Personal   Professional
If yes, how many years’ experience do you have as a CAREGiver?
Less than 1 year   1-2 years   3-5 years   5+ years

EDUCATION
* Please select the highest level of education completed:
Less than High School   High School Graduate or GED   Technical School; Some College   2-Yr College/Assoc degree   4-Yr College Bachelor degree and above

WORK HISTORY
Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.

MOST RECENT EMPLOYER

* Are you currently working for this employer?
Yes   No
* If yes, may we contact?
Yes   No
* Company Name:
* City:
* State:
* Company Phone:
* Dates Employed - From:
* Dates Employed - To:
* Job Title:
* Supervisor's Name:
* Duties:
* Salary:* Per Hour/Week/Month:
* Reason for Leaving:

SECOND MOST RECENT EMPLOYER

* Are you currently working for this employer?
Yes   No
* If yes, may we contact?
Yes   No
* Company Name:
* City:
* State:
* Company Phone:
* Dates Employed - From:
* Dates Employed - To:
* Job Title:
* Supervisor's Name:
* Duties:
* Salary:* Per Hour/Week/Month:
* Reason for Leaving:

BACKGROUND INFORMATION
As a condition of employment, all employees must be "Bondable".

List states and cities of residence for the past ten (10) years:
* City:* State:
City:State:
City:State:
City:State:

* Have you been a resident of Pennsylvania for a minimum of two (2) years?
Yes   No
* Have you ever had any moving traffic violations?
Yes   No
If yes, please explain giving year and violations:
* Do you have any pending criminal action at this time?
Yes   No
If yes, please describe:
* Have you ever been convicted of a felony and/or misdemeanor?
Yes   No
If yes, please describe:


REFERENCES
Please complete all four references (two professional/two personal). Your application will not be considered unless four references are provided. Since we will contact these references, please notify them in advance. Do not include relatives.

Professional References
Full Name Phone Number Best Time of
Day to Call
Email Relationship Number of
Years
Known
*
*
*
AM   PM
*
*
*
*
*
*
AM   PM
*
*
*

Personal References
Full Name Phone Number Best Time of
Day to Call
Email Relationship Number of
Years
Known
*
*
*
AM   PM
*
*
*
*
*
*
AM   PM
*
*
*
CERTIFICATION AND RELEASE
I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT FOR EMPLOYMENT

* Signature (type full name):
* Date:
Release v4 & Authorization for CBC & Drug Screen
Background Check Notice and Disclosure

Through this document, Greater Pittsburgh Homecare Services, Inc, d/b/a an independently owned and operated Home Instead Senior Care franchise ("the Company"), is providing you with notice that it intends to procure a consumer report on you for employment purposes or as part of the pre-employment background investigation/application process.

Your signature on the "Authorization for Procurement of Consumer Report" form provided along with this Notice and Disclosure authorizes the Company to procure a consumer report for employment purposes and for pre-employment screening.

The consumer report may include, but is not limited to, the following types of information: social security number verification, address history (skip trace), criminal records information, public court records information, driving records information.


Authorization for Procurement of Consumer Report

I have carefully read and understand the "Background Check Notice and Disclosure" I have been given, and this Authorization form. By my signature below, I consent to the release of consumer reports to Greater Pittsburgh Homecare Services, Inc, d/b/a an independently owned and operated Home Instead Senior Care franchise ("the Company"), for employment purposes and/or as part of the pre-employment background investigation.

I understand that, to the fullest extend allowed by law, information contained in my employment application or otherwise disclosed to the Company by me in the hiring process or during my employment may be utilized for the purpose of obtaining consumer reports.

If hired, or if already employed, this authorization shall remain on file and shall serve as an ongoing authorization for the Company to obtain consumer reports, at any time during my employment, for employment purposes. Further, if hired, or already employed, my signature below authorizes the Company to supply my employment history with the Company to a consumer reporting agency.

My signature below signifies my receipt and understanding of the "Background Check Notice and Disclosure" and authorizes the Company to obtain consumer reports regarding me.


* First Name:* Last Name:Middle Initial:
Maiden/Previous Names: 
* Home Address:* City:
* State:* Zip Code:
* Social Security Number:* Date of Birth:
Driver's License Number:Issuing State:

* Signature (type full name):
* Date:

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