The care you need from the comfort of your home.

 

Employment Application
Elder Alternatives Incorporated
Is a participant in the E-Verify Program with USCIS
All qualified applicants will be considered without discrimination because of race, color, religion, sex age, disability, national orgin, or veteran status.
 

Click Edit Form to add form elements. You can enter a form description and instructions here.

Frist Name: *
Middle Name: *
Last Name: *
Social Security Number: *
  Yes No    Are you 18 years of age or older?
Address
Street: *
City: *
State/Zip: *
Home Phone Number:
Cell phone number:
Email Address:
Position applying for/minimum salary desired:
Next of kin or guardian, telephone number:
Tell us about your work experience:
Company Name:
Position/dates of employment:
Supervisor/phone number:
Company Name:
Position/dates of employment:
Supervisor/phone number:
Tell us about your Education:
High School/dates:
Vocational School/dates:
College/dates:
When can you work:
Date/ time: *
  yes no  Are you available for Live-in's?
List and professional groups, organizations, or hobbies relevant to your ability to perform the job that you are applying for:
Have you ever been convicted of a Felony?    
   
yesno
If yes please explain:
Are you legally eligible for employment in the U.S.?
 
yesno 
If no please explain:
  Have you ever been employed by us?
yes no
If yes please explain:
  Do you have any relatives employed by us?
yesno
 If yes please let us know who:
  Do you have a valid driver's license?
yesno
  Do you have a car with air conditioning? (Not a truck or SUV for our clients)
yesno
How did you hear about us?:
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