Client Employment Application

Employment application for placement with Caring Hands Agency client. All are required to pass a criminal background check, possess a current CPR certification and provide verifiable industry related references.
If you are having technical issues with application, please let us know at info@caringhands.agency.

Caring Hands Agency Client Employment Application

Please review before starting to ensure you have all the information you need.

* Indicates required field

Applicant Name *

First

Last

Current Address *

Line 1

Line 2

City

State

Zip Code

Country

Closest Major Intersection to Your Home *

Name of Apartment, Townhome, or Housing Community *

Date of Birth *

Place of Birth *

Are you a legal US citizen? *

Marital Status *

Cell Number *

Home Number *

Email *

If currently employed, please note where/occupation/hours employment: *

Will this employment continue if hired for this position? *

Fluent English (reading, writing, speaking with no outside assistance) is required to apply for CHA; otherwise, please list any other languages you speak/understand *

List any physical or mental limitations that could impair your ability to do this job: *

Do you currently: smoke, drink alcohol, use daily drugs (with or without prescription), or take any mood altering medications (ex: but not limited to, Valium, Zanex, or prescription pain meds)? If yes, please explain: *

Please describe your philosophy of child discipline, as it relates to other peoples children that you might be caring for: *

Times Available *

Daytime Hours Evening Hours Weekends

Comments on Times Available *

ChildCare References

Please list 3 professional references with at least 2 professional childcare/work related.

Contact #1 *

Address *

Contact # *

Start Date *

End Date *

# of Children/Ages cared for? *

Contact #2 *

Address *

Contact# *

Start Date *

End Date *

# of Children/Ages cared for? *

Contact #3 *

Address *

Contact # *

Start Date *

End Date *

# of Children/Ages cared for? *

Education

High School Attended *

Diploma? *

College Attended *

Diploma/Degree? *

Field of Study *

Degree/Certification *

CPR Certification? *

CPR certification is required and needs to be current prior to interview.

Expiration Date *

List any other degrees, certifications, etc... *

Background check info

Driver's License Number *

State Where License is Issued *

Social Security Number *

Have you ever been arrested for any reason? *

If yes, please explain. *

CHA has your permission to screen public records for criminal/sex offender/driving records at the local/non-local basis, should they be needed and I am willing to submit finger print verifications should they be requested.

Have you anything to declare? *

Please type your name here to agree to a background check. *

Emergency Info

Please list name, relationship, and all phones for emergency contact that we are authorized to contact in case of serious emergency: *

You will be required to provide any legal work docs, DL & SS card copy, CPR documentation proof, and any additional references you wish us to consider prior to or at interview. Contractor applications generally take 5 business days to screen a candidate, but can take longer depending on swift responses from references-please advise those you have listed so that they may be aware that we will be contacting them to receive their comments for reference purposes.

Please list any other information you would like for us to consider. *

How did you hear about us? *

Submit