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Home Health Aide
Comfort Keepers PA
Basic Information
Upload resume
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First name
Last name
Email
Phone
Phone
Country
State (optional)
City
Street
Postal code
Personal Information
How long at this address?
Previous Address
How long at this address?
Social Security Number
Cell Phone
Best time to call you
What date are you available for employment
Type of employment desired
Full Time
Part Time
Temporary
Seasonal
Are you able to meet the attendance requirements for this position?
Yes
No
Have you previously applied for a position with Comfort Keepers?
Yes
No
Have you previously worked at Comfort Keepers?
Yes
No
Are you eligible to work in the United States?
Yes
No
If you are under 18, can you furnish a work permit?
Yes
No
Have you ever been convicted of/or plead guilty to a crime (other than minor traffic violations)?
Yes
no
If yes, please explain: (give date, location, charge, etc.)
If the job requires, do you have a valid driver's license?
Yes
No
DL #
Type
State of Issue
Have you had any moving violations in the past 3 years?
Yes
No
If yes, please describe
Do you have any relatives currently employed by Comfort Keepers?
Yes
No
If yes, please list
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodations?
Yes
No
If no, describe the functions that cannot be performed
Experience & Education
Add education
Add experience
License / Certification
Type
State of Issue
Number
Active
Yes
No
Type
State of Issue
Number
Active
Yes
No
Caregiver Availability
Please enter the earliest you can start and the latest you can work each day of the week you are available. If you are not available, please leave that day blank.
Monday (Day 7am - 5pm) (Evening 5pm - 10pm) (Overnight 10pm - 7am)
Tuesday (Day 7am - 5pm) (Evening 5pm - 10pm) (Overnight 10pm - 7am)
Wednesday (Day 7am - 5pm) (Evening 5pm - 10pm) (Overnight 10pm - 7am)
Thursday (Day 7am - 5pm) (Evening 5pm - 10pm) (Overnight 10pm - 7am)
Friday (Day 7am - 5pm) (Evening 5pm - 10pm) (Overnight 10pm - 7am)
Saturday (Day 7am - 5pm) (Evening 5pm - 10pm) (Overnight 10pm - 7am)
Sunday (Day 7am - 5pm) (Evening 5pm - 10pm) (Overnight 10pm - 7am)
Application Questions
Do you have a valid driver's license?
Yes
No
Additional Information
Cover letter (optional)
Portfolio (optional)
Optional Demographic Survey
Your participation in this survey is voluntary. You may provide as much information as you are comfortable with. If you decide not to participate in this study or provide partial information, it will not affect your chances of employment.
Select your sex
Male
Female
What is your race/ethnicity?
Hispanic or Latino
A person from Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race
White
A parson having origins in any of original people of Europe, the Middle East, or North Africa
Black or African American
A person having origins in any of the black racial groups of Africa
Asian
A person having origins in any of original peoples of Fast East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, Chine, India,Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
Native Hawaiian or Other Pacific Islander
A person having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands
American Indian or Alaska Native
A person having origins in any of original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Two or More Races
A person who primarily identifies with two or more of above race/ethnicity.
Veteran status
Vietnam Era Veteran
(i) A person who served on active duty for a period of more than 180 days and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred in the Republic of Vietnam between February 28, 1961 and May 7, 1975, or between August 5, 1964 and May 7, 1975, in all other cases, or (ii) A person who was discharged or released from active duty for a service-connected disability of any part of such active duty was performed in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or between August 5, 1964 and May 7, 1975, in all other cases.
Special Disabled Veteran
Special Disabled Veteran: (i) A veteran entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under the laws administered by the Department of Veterans' Affairs for disability who is rated at 30 percent or more or who is rated at 10 or 20 percent in the case of a veteran who has been determined under Section 3106 of Title 38, U.S.C. to have a serious employment handicap or (ii) A person who was discharged or released from active duty because of a service-connected disability.
Other Eligible Veteran
Other Protected Eligible Veteran: A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense.
Newly Separated Veteran
Newly Separated Veteran: Any veteran who served on active duty in the U.S. military, ground, naval or air service during the past one-year period, beginning on the date of such veteran's discharged or released from active duty.
Not Applicable
Disability Status
Individual with Disabilities
A person has disability if he or she a physical or mental impairment which substantially limits one or more major life activities; has a record of such impairment; or is regarded as having such impairment. A handicap is "substantially limiting" if it is likely to cause difficulty in securing or advancing in employment.
Not Applicable