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 Date Applying For:* Please selectCaregiverCNALIVE-INManagerCOOController/VP Finance I am available for* Please selectFull TimePart TimeLive-In Are you a CNA?* Please selectYesNo Job Location* Please selectDallasSt Michaels DriveTranquillaSpring ValleyQueens Ferry CNA License #* CNA Certificate Expiration Date:* Name First Last Nickname / Preferred Name Date of Birth* Social Security Number Address Address* City* ZIP* Email address* Phone Number * Are you legally eligible for employment is the U.S.A.? * YES NO COVID Vaccinated?* YES NO Do you have a valid operator’s (driver’s) License?* YES NO Manchester Care Homes Availability Please select the days and times you are available to work Monday 6am – 2pm 2pm – 10pm 10pm – 6am Tuesday 6am – 2pm 2pm – 10pm 10pm – 6am Wednesday 6am – 2pm 2pm – 10pm 10pm – 6am Thursday 6am – 2pm 2pm – 10pm 10pm – 6am Friday 6am – 2pm 2pm – 10pm 10pm – 6am Saturday 6am – 2pm 2pm – 10pm 10pm – 6am Sunday 6am – 2pm 2pm – 10pm 10pm – 6am Skill & Experiences: Skills Cooking Cleaning Driving Elder Engagement Experience Hoyer Lift Gait Belt Incontinence Care Medication Reminder Dementia Patient Care ALS Patient Care Other Skills Select Cooking Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select Cleaning Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select Driving Expertise LevelYESNO Elder Engagement Experience Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select Hoyer Lift Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select Gait Belt Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select Incontinence Care Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select Medication Reminder Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select Dementia Patient Care Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Select ALS Patient Care Expertise LevelBasic ExperienceModerate ExperienceHighly Experienced Education and Professional Designations: Name of School Course of Study Did you graduate Diploma Earned Name of School Course of Study Did you graduate Diploma Earned Other 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: From To Starting wage Ending wage: Name of Supervisor Phone# May we contact this employer? YES NO Location: Describe your duties and responsibilities: Reason for leaving Would you like to add another employment history? YES NO Employment History 2: Name of company and type of business: Dates employed with company: From To Starting wage Ending wage: Name of Supervisor Phone# May we contact this employer? YES NO Location: Describe your duties and responsibilities: Reason for leaving Please read the terms and conditions The 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 above Want 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] Send This field should be left blank
