Do you prefer to work with males or females?
Please indicate the following assistance you are willing and able to perform for clients.
Do you own your own transportation?
BACKGROUND: A background screening with the Family Care Safety Registry must be performed prior to employment.
Have you been charged with an offense other than a minor traffic violation?
If you are not a high school graduate, do you have your GED?
Have you graduated or attended college?
What area of study and/or degree?
Do you have any license and/or certifications?
May we contact this past employer?
I (print name), certify the answers I have provided are true. I hereby give Haney’s Heart-to-Heart In-Home Care LLC, permission to conduct a background screening for employment purposes.
Note: Any deliberate and/or false information can/will result in immediate disqualification.
______Eligible _____Ineligible for employment with Haney’s Heart-to-Heart In-Home Care LLC.