Apply for Home Health Aide- Lehigh/Cape Coral/Naples/Fort Myers/

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Home Health Aide- Lehigh/Cape Coral/Naples/Fort Myers/
ID:1001
Location:N/A
Department:Client Services
Resume
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Documents needed to proceed
To help streamline the interview and hiring process, please upload the needed documents below.

Para ayudar a agilizar el proceso de entrevista y contratación, cargue los documentos necesarios a continuación.
* Copy of your Drivers License
* Are you a U.S. Citizen? If no, Please upload Permanent Resident Id or working authorization letter.
Yes
No
* Upload your permanent Resident card or work authorization letter.
* Copy of your Social Security Card
* RESUME
* REFERENCE NAMES AND NUMBERS.
* Letter of Recommendation example: from past job, teacher, school, supervisor,
* HHA or CNA Certificate
* CPR
*AMERICAN HEART ASSOCIATION
*RED CROSS*
* Inservices for HIPPA
* IN SERVICE INFECTION CONTROL
* Inservices for HIV
* Inservice ALZHEIMERS
Yes
No
* ALZHEIMERS INSERVICE
* LOCAL LAW CHECK BACKGROUND from Local Police Department
* Level 2 AHCA Background fingerprints?
Yes
No
* Physical with TB test
* Liability Insurance for Caregivers
Perez Healthcare Group Application
Personal Information
General Availability
When are you available to work? (check all that apply)
*
Anytime
Mornings
Afternoons
Nights
Weekdays
Weekends
Yes   No
Skills and Preferences
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Education

High School

Yes   No

College 1

Yes   No

College 2

Yes   No
Experience
Personal experiences like caring for your grandmother or a child with special needs is acceptable.

Most recent

Yes   No

Next Most recent

Yes   No

Next Most recent

Yes   No

Next Most recent

Yes   No

Next Most recent

Yes   No
References

Reference 1

Reference 2

Reference 3

Reference 4

Reference 5
Additional Questions
Yes   No
Certification and Release
I certify the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentation of facts will result in rejection from this application and/or discharge at any time during employment period. I authorize "The Company" to verify any and all information contained within this application, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment.

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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