Once your application is submitted we will contact you directly. Applications are processed in the order they are received. How did you hear about us/Referred by?Application DateApplying For:*Please selectCaregiverCNALIVE-INManagerI am available for*Please selectFull TimePart TimeLive-InAre you a CNA?*Please selectYesNoJob Location*Please selectDallasSt Michaels DriveTranquillaSpring ValleyQueens FerryCNA License #*CNA Certificate Expiration Date:*NameFirstLastNickname / Preferred Name Date of Birth*Social Security NumberAddressAddress*City*ZIP*Email address*Phone Number *Are you legally eligible for employment is the U.S.A.? *YESNOCOVID Vaccinated?*YESNODo you have a valid operator’s (driver’s) License?*YESNOManchester Care Homes AvailabilityPlease select the days and times you are available to workMonday6am – 2pm2pm – 10pm10pm – 6amTuesday6am – 2pm2pm – 10pm10pm – 6amWednesday6am – 2pm2pm – 10pm10pm – 6amThursday6am – 2pm2pm – 10pm10pm – 6amFriday6am – 2pm2pm – 10pm10pm – 6amSaturday6am – 2pm2pm – 10pm10pm – 6amSunday6am – 2pm2pm – 10pm10pm – 6amSkill & Experiences:SkillsCookingCleaningDrivingElder Engagement ExperienceHoyer LiftGait BeltIncontinence CareMedication ReminderDementia Patient CareALS Patient CareOther Skills Select Cooking Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect Cleaning Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect Driving Expertise LevelYESNOElder Engagement Experience Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect Hoyer Lift Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect Gait Belt Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect Incontinence Care Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect Medication Reminder Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect Dementia Patient Care Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedSelect ALS Patient Care Expertise LevelBasic ExperienceModerate ExperienceHighly ExperiencedEducation and Professional Designations:Name of SchoolCourse of StudyDid you graduateDiploma EarnedName of SchoolCourse of StudyDid you graduateDiploma EarnedOther Training:Your preferred starting wage:Desired number of hours:Desired Start Date:Employment History:Please list your past three employers, starting with your most recent job. Supervisors ONLY. No Co-Workers.Name of company and type of business:Dates employed with company:FromToStarting wageEnding wage:Name of SupervisorPhone#May we contact this employer?YESNOLocation:Describe your duties and responsibilities:Reason for leavingWould you like to add another employment history?YESNOEmployment History 2:Name of company and type of business:Dates employed with company:FromToStarting wageEnding wage:Name of SupervisorPhone#May we contact this employer?YESNOLocation:Describe your duties and responsibilities:Reason for leavingPlease read the terms and conditionsThe information contained in this application is true and complete. I understand that false, misleading or inaccurate statements contained (or omitted) in this application may be grounds for immediate dismissal. I understand and acknowledge that any offer of employment shall be subject to the successful completion of criminal and credit background checks. I hereby consent to Cambridge Caregivers and/or Manchester Care Homes performing criminal, credit and background investigations on me.I agree to the terms & conditions aboveWant to leave message or comment?Once your application is submitted, please do not contact us directly. Applications are processed in the order they are received.Legal Document: Pre-FilledForm3649.pdf Please download, fill up and mail to: [email protected] SendThis field should be left blank
