Employment Eligibility Verification

Employment Eligibility Verification
Name *

First Name Last Name
E-mail *
Do you have at least 2 years of caregiver experience? *

Yes No
Are you registered with the State of California as a Home Care Aide? *

Yes No
Are you at least 21 years or older? *

Yes No
Do you have personal care experience? *

Yes No
Do you have a positive work attitude? *

Yes No
Do you have a strong work ethic? *

Yes No
Are you fluent in English? (spoken and written) *

Yes No
Do you currently have a valid driver's license that is in good standing? *

Yes No
Do you have daily access to a reliable vehicle with current registration and valid proof of insurance? *

Yes No
Have you had LiveScan Fingerprinting in the past? *

Yes No
Do you love helping others? *

Yes No
Are you CPR certified? *

Yes No
Have you had a negative TB test or chest X-ray within the last two years or able to complete one within 7 days of hire? *

Yes No
Are you eligible to work in the United States? *

Yes No
Do you understand that drug testing can be done at random? *

Yes No
I hereby certify that the information I have provided or indicated above is true to the best of my knowledge. I understand that providing false information may result in disqualification for employment eligibility and consideration. *

I agree
Upon selecting the "Submit" button below, your answers will be assessed. Those who are eligible to submit job applications based on the answers provided will receive an e-mail momentarily containing a link to complete your employment application.
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