* Required Information
I want to apply for a position as
*
- Please select -
Personal Care Provider
Relative Personal Care Provider
Office Employee / Customer Service Representative
Field Supervisor
Accounting Bookkeeping
Other / Any Available
I want to work
*
- Please select -
Part-Time
Full-Time
I am flexible
First Name
*
Last Name
*
Gender
Male
Female
Age
- Please select -
Prefer not to say
19-25
26-35
36-50
50-60
Over 60
Phone Number
*
Email
*
Address
City
State / Province / Region
Zip / Postal Code
Country
Education
Some High School
Completed High School
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
Do you have a Connecticut Driver's License?
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Yes
No
Do you have reliable transportation?
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Yes
No
Languages
English
Spanish
Russian
Vietnamese
Other
Any other languages
Can you stoop/bend and lift up to 25 pounds?
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Yes
No
Have you ever worked for a Home Care Agency or Facility?
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Yes
No
If yes, state position, name of agency & length of employment
Do you have any experience in the following
Meal Preparation
Housekeeping
Bathing
Dressing
Transfers
Incontinence Care
Dealing with bed-bound patients
Alzheimers/Dementia Care
Parkinsons Care
How many hours a week are you looking for?
*
- Please select -
up to 10 hours / week
up to 10-19 hours / week
up to 20-29 hours / week
up to 30-39 hours / week
up to 40 hours / week
Which days of the week can you work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time of day can you work?
Mornings
Afternoon
Evenings
All day
No preference
Check areas you are available to work in
Berlin
Cromwell
Durham
East Hampton
Farmington
Glastonbury
Marlborough
Meriden
Middlefield
Middletown
New Britain
Newington
Portland
Rockyhill
Southington
Expected Pay Rate (USD/hour)
We do drug testing and criminal background checks. Is there anything going to show up on yours?
*
Yes
No
Please lists 2 personal and professional job references