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Helping Us Help U Home Care,LLCHelping Us Help U Home Care,LLC
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Employment Application

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Employment Application
WE ARE AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
It is the policy of Helping Us Help U Home Care, LLC to afford equal employment opportunity to all qualified persons regardless of race, color, religious creed, national origin, age, military status, sexual orientation, disability, genetic information, gender identity, gender expression or gender unless based upon a bona fide occupational qualification.
PERSONAL INFORMATION
Name*
Address*
MM slash DD slash YYYY
Are you authorized to work in the U.S. on an unrestricted basis?*
Are you 18 years or older?*
Who referred you?

EMPLOYMENT DESIRED
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Have you worked for the Quality Life/ CANAS before?
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MM slash DD slash YYYY
Are you available for full-time work?*
Are you available for part time work?*
Have you reviewed the essential functions of the job as listed on the job posting?*
EDUCATION
Details*
Name of School
City
State
Main Course of Study
Did you Graduate
Degree
Years Attended
 
List any additional education or training*
EMPLOYMENT HISTORY
Complete All Information In Full. All Applicants Must Complete This Page Even If They Are Also Submitting A Resume. Begin With Your Most Recent Employment, Including Any Present Employment. Your Present Employer Will Not Be Contacted Without Your Permission. You May Include Any Verifiable Work Performed On A Volunteer Basis. Any Gaps In Employment Must Be Briefly Explained.
Are you employed now?*
May we contact?
Address*
MM slash DD slash YYYY
MM slash DD slash YYYY
Add more
PROFESSIONAL REFERENCES (not personal)
Details
Name
Address
Occupation
Telephone Number
Years Acquainted
 
MISCELLANEOUS JOB-RELATED INFORMATION
Are you available to work EVERY other Saturday?
CERTIFICATIONS AND LICENSES
List any professional licenses, registrations or certifications you possess.*
License
License Number
Date Issued
State Issued
Expiration Date
 
LANGUAGE CAPABILITIES
Language*
English Speaking*
English Reading*
English Writing*
Spanish Writing*
Spanish Reading*
Spanish Writing*
Do you have any criminal history?*
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Helping Us Help U Home Care, LLC to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Helping Us Help U Home Care, LLC serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, to file a State security questionnaire and State loyalty oath, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only and would be ineligible for benefits including paid time off. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first THREE MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.
Signature of Applicant:*
Clear Signature
Max. file size: 4 GB.
MM slash DD slash YYYY

Helping Us Help U Home Care, LLC is dedicated to providing compassionate, reliable, and personalized non-medical home care services. We are here to support comfort, dignity, and independence while helping you or your loved ones feel safe and cared for at home.

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  • Indianapolis, IN
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