Home Health Aide / Personal Care Aide by firstamericare | Mar 21, 2021 Next ›Apply OnlineApply OnlineGeneral Information*Name:*Social Security*Date of BirthCurrent Address:*Street*Home Telephone*City*State*Zip Code*Daytime TelephonePlease select positions you want to apply for.Position(s) desired Home Health Aide Home Health Aide 2 Home Health Aide 3 *Date of availability*Preferred Work Schedule Day Evening Night *Are you permitted to work in the United States on a regular basis (i.e. other than temporary)? Yes No Education*High School/ Equivalent*Completed (Y/N) Yes No *Major*From Mo./Yr*Degree ReceivedAdditional EducationProfession:*Professional Licensure(s)/Registration(s)/Certification(s)*Number*Yr. Received*Date of ExpirationProfessional AssociationsEmployment History:*Time Employed (Mo. & Yr.)*From*to*Job Title*Position Responsibilities*Employer’s Name*Employer’s Address*Supervisor’s Name & Title*Phone No*Reason for LeavingList of supporting documents Please submit following with application of employment. Thank you1. Copy of Passport page with your name (List A Form I – 9 )orDriver lic and Social security card ( List B and List C Immigration form I-9 )*Latest proof of PPD OR Chest X Ray*Professional License Copy ( RN/LPN/PT/OT)*Copy of void bank check for Direct Deposit form*Copy of CPR/ACLS cardi certify that the information on this application is true and complete to the best of my knowledge i understand that any misrepresentation willful omission false or misleading information is grounds for rejection of this application form refusal to hire withdrawal of an offer of employment or immediate discharge whenever discovered you are authorized to conduct investigations including verification of prior employment history and education i also understand that employment is dependent upon receipt of acceptable employment references and satisfactory completion of pre-employment health screening which will include illicit drug and alcohol testing and provision of documents required by the immigration reform and control act of 1986 1st americare llc home health does not discriminate against any qualified person because of age race color religion sex national origin disability or sexual orientation by signing this application i acknowledge that an offer of employment at 1st americare llc home health should not be interpreted as an offer of continued or permanent employment*Date*SignatureFields with (*) are compulsory.