Apply for Caregiver (CNA/HHA)

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Summary
Title:Caregiver (CNA/HHA)
ID:1169
Location:Seattle, WA
Department:Client Services
Salary Range:$22.00-$25.00
Resume
Resume:
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
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* Zip:
* Phone:
* Email:
Opt-In Confirmation
I authorize recruiters from Family Best Care to send text messages from 8556269041 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.
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Cover Letter:
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Applicant Questions
* Are you authorized to work in the United States?
Yes   No
* Do you have a Social Security Number?
Yes   No
* Have you ever been convicted of a felony?
Yes   No
* Are you willing to consent to a background check?
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* Do you have a vehicle?
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* Are you available throughout week for Fill In shifts as they arise?
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* Date Available To Start
Referred By
* What days are you available to work? Select all that apply.
  
  
  
  
  
  
* What shifts are you able to work? Select all that apply.
  
  
  
* Please select all certifications/licenses you have
  
  
  
  
FBC Disclaimer
Please Review & Sign.

DISCLAIMER AND SIGNATURE                          
   
1. I certify that all information given by me on this application and attached resume (if applicable) is true, complete, and correct to the best of my knowledge.  I understand that if I am employed, a discovery that I gave false or misleading information during the application process may result in immediate dismissal.  
2. I authorize Family Best Care, LLC here to solicit information regarding my character, general reputation, criminal history, previous employment, education, military service, and similar background information, and to contact any and all references I have given on my application and resume.  I hereby release all parties and persons connected with any such request for information from all claims, liabilities, and damages for any reason arising out of the furnishing of such information.  If employed, I release Family Best Care, LLC from any liability for future references it may provide regarding my work history with Family Best Care, LLC.
3. I understand that upon my approval to submit my resume and/or upon my interview with a client of Family Best Care, LLC I am obligated not to accept direct or indirect employment with that client for a period of two years (2) unless I have received written consent from Family Best Care, LLC further acknowledge that during an assignment or following the completion of an assignment with a client of Family Best Care, LLC that I may not accept direct or indirect employment for a period of two (2) Years unless I have received written consent from Family Best Care, LLC
4. I understand and agree to allow Family Best Care, LLC to release the Employment History section to clients upon request.  
5. I understand all information which I obtain through the application or employment process, pertaining to Family Best Care, LLC and/or clients to whom I have been referred by Family Best Care, LLC, is confidential and shall not be disclosed at any time.  
6. I understand that Family Best Care, LLC is an “at-will” employer.  I understand that my employment can be terminated with or without cause, and with or without notice at any time, at the option of Family Best Care, LLC or myself.  I understand that no representative of Family Best Care, LLC other than the CEO or President, has any authority to enter into any agreement for employment for any specified period or to make any agreement contrary to the foregoing.
7. Drug and Alcohol Testing: I understand that Family Best Care, LLC reserves the right to conduct drug and alcohol testing as permitted by applicable law. I consent to random, reasonable suspicion, or post-incident drug and alcohol testing, and understand that a positive result or refusal to submit to such testing may result in disciplinary action, up to and including termination of employment.

* Signature
* Date
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
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Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Vietnam Era Veteran
A person who 1) 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; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition 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.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

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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