Apply Online with Home Health Care Plus

**For Employment Consideration All Fields are Required**
Home Health Care Plus is an equal opportunity employer and complies with all provisions of Title VI of the Civil Rights Act as amended and Title I of the Americans with Disabilities Act of 1990. Home Health Care Plus also complies with applicable provisions of the Fair Labor Standards Act as amended. Applicants requiring reasonable accommodation to the application and/or interview process should notify the Human Resources Department.
Applicant Information
Driver License State

Date of Birth

Organization Telephone Contact Person Dates Worked May We Contact Ver
Contact Person Telephone Position/Title Dates Known Ver

Criminal History

Name Location Major Graduate? End Date
Name Location Graduate? End Date

Availability - To be considered for employment all applicants must fill-in availability hours
Live-Ins - Being a Live-In means several consecutive days of care where the Caregiver stays at the care recipient's home for the entire number of days.

Skills and Preferences

Attributes List

Specialized Training

Additional Questions

Emergency Contact Information
Name Relationship Cell Phone Home Phone

I certify the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentation of facts will result in rejection from this application and/or discharge at any time during employment period. I authorize Home Health Care Plus to verify any and all information contained within this application, 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 also understand that the use of illegal drugs is prohibited during employment and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment.

I agree not to do business directly with any individual or business entity that Home Health Care Plus has introduced to me or by entering into employment with such individuals or businesses.