Apply for Direct Care Worker

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

Summary
Title:Direct Care Worker
ID:Port Carbon, PA
Job ID:Scranton, PA
Town:Port Carbon
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Caregiver Application for Employment
General Availability
Yes   No
When are you available to work? (check all that apply)
Anytime
Mornings
Afternoons
Nights
Weekdays
Weekends
Skills and Preferences
  
  
  
  
  
  
  
  
  
  
Yes   No
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 - 2 References (non family members) are required
*
*
*
*
*
*
*
*
EMERGENCY CONTACT INFORMATION
CERTIFICATION
I certify that the statements made in this application are true and correct. I understand and agree that any deliberate misstatement or willful omission of any fact will result in the rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery.
I further understand and agree that the employment relationship that may result from my application will be an employment-at-will, which means that either I or any Independence Care entity which I may have an employment relationship, may terminate the relationship, with or without notice, at any time, for any reason or for no reason at all. I understand that the at-will nature of that relationship cannot be changed except in writing, signed by an officer of the Independence Care entity of which I am employed.
I understand and agree that Independence Care requires applicants and employees to complete a criminal background check pursuant to state law. All information obtained as a result of a criminal background check will be kept confidential and will be used solely for employment purposes.
Prescreening Questions-1
* Are you 18 years or older?
Yes
No
* Do you have access to reliable transportation?
Yes
No
* How far are you willing to travel to work?
1 - 15 Miles
15 - 30 Miles
30 - 45+ Miles
* How many hours a week are you willing to work?
0 - 20 Hours
20 - 30 Hours
30 - 40 Hours

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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