Apply Online with Attenda Home Care LLC

Applicant Information
Driver License State

Organization Telephone Contact Person Dates Worked May We Contact Ver
Contact Person Telephone Position/Title Dates Known Ver

Criminal History

Name Location Major Graduate? End Date
Name Location Graduate? End Date

Live-Ins - Being a Live-In means several consecutive days of care where the Caregiver stays at the care recipient's home for the entire number of days.

Skills and Preferences

Specialized Training

Additional Questions

Emergency Contact Information
Name Relationship Cell Phone Home Phone

I certify that all the information I have provided is true, complete and correct.
The information contained within this application or any cover letter or resume attached is not shared with any third parties. The information is used by the employer only as an aid in the hiring decision making process. The applicant, by submitting the application gives the employer consent to collect the information contained herein and use for the purpose specified.
I authorize Attenda Home Care to investigate all statements contained on this application. I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal.
I understand that if I am hired, I will be required to provide criminal background check, proof of identity and legal authority to work in Virginia, proof of certifications or educational qualifications, and a drivers abstract (if applicable).
Furthermore, I understand and agree that if employed, I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not in any way constitute an agreement or contract for employment.