Specializing in 24 hour in home care, consisting of both personal care assistance and homemaker service. Be assured that all our staff have been through extensive training in all areas of CPR, Homemaking & Personal Care Assistance. Your personal and medical records will be treated with strict confidentiality by our entire professional staff. We provide the highest standard of in-home living assistance, keeping intact our clients independence and personal dignity.
 
   Employment Application  
     






 
 

Click here to download the printable employment application or you may fill out the online application below.

Personal Care Attendant Requirements
High School Diploma or Equivalent
Current Drivers License and Insurance
Social Security Card and/or Resident Alien Card
TB Test
CPR / 1st Aid Certification
Criminal Background Check
Physical
References
Training for PCA Certification
Personal Care Attendant Experience Preferred

 

Application Information
Last Name:
First Name:
M.I.:
Date:
Street Address:
Apartment #
City:
State:
Zip:
Phone:
Email Address:
Date Available:
Social Security #:
Date of Birth:
Position Applied:
Desired Salary:

Are you a Citizen of the United States:
Yes   No

If no, are you authorized to work in the U.S?
Yes   No

Have you ever work for this company?
Yes   No
If so, when?

Have you ever been convicted of a felony?
Yes   No
If yes, explain?
   

Education

 
High School:
Address:
From:
To:
Did you graduate? Yes   No
Degree?
   
College:
Address:
From:
To:
Did you graduate? Yes   No
Degree?
   
Other:
Address:
From:
To:
Did you graduate? Yes   No
Degree?
   

References

 

Please list three professional references.

Full Name:
Relationship:
Company:
Phone:
Address:
   
Full Name:
Relationship:
Company:
Phone:
Address:
   
Full Name:
Relationship:
Company:
Phone:
Address:
   

Previous Employment

 
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving?

May we contact your previous supervisor for a reference?
Yes   No
   
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving?

May we contact your previous supervisor for a reference?
Yes   No
   
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving?

May we contact your previous supervisor for a reference?
Yes   No
   

Military Service

 
Branch:
From:
To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
   
Disclaimer & Signature
By submitting this application I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

 
   
 

Angel Care Home Health Services - 4080 E. Lakemead Blvd Ste. C101 Las Vegas, NV 89115 - Office: 702-731-5587  Fax: 702-731-5597
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