professionalhomecarespecialist@gmail.com

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Employment Application

Employment

Employment Application

Employment Application

Application for Employment

Professional Homecare Specialists 9 Industrial Street Suite 3, 04769 ( (207) 762-5486 / fax; 207-540-1128 )

Professional Homecare Specialists In Home Care Agency" is an Equal Opportunity Employer (EEO) Applicants and/or employees are considered for hire, promotion and job status, without regard to race, color, religion, creed, sex, marital status, national origin, age, physical or mental disability.

Mission Statement

It's the mission of "Professional Homecare Specialists", to provide, within community settings, supervise, safe, and comfortable environments in which to care for, support, and empower our clients with disabilities to actualize their fullest potential.

In Order to Be Considered for Employment Please Thoroughly Complete the Application.

Employment Application Page - Application Form

First Name *

Last Name *

Address*

Street Address

Address Line 2

City

State / Province

ZIP / Postal Code

Phone *

Email *

Position(s) Applying For *

Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation? *

Yes

No

Days Available to Work *

No Preference

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How many hours can you work weekly? *

How many hours can you work weekly? *

Can you work evenings/nights/weekends/holidays? *

Yes

No

Have you ever filed an application with us? *

Yes

No

Have you ever been employed by us before? *

Yes

No

Are you legally able to work within the United States? *

Yes

No

Do you meet the minimum age requirements to work in Maine? *

Yes

No

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Other than Secretarial Positions, are you able to:

1. Sit *

Yes

No

2. Walk *

Yes

No

3. Stand *

Yes

No

4. Lift and carry 45 lbs consistently *

Yes

No

5. Both push and pull objects *

Yes

No

6. Spend time indoors and outdoors *

Yes

No

7. Follow and implement oral directions *

Yes

No

8. Accurately record data and observations *

Yes

No

9. Follow and implement written instructions *

Yes

No

10. Safely operate a motor vehicle with no adaptations *

Yes

No

If the answer to 1-10 is no, please indicate what accommodation you may need in order to complete this job responsibility

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SKILLS

Please list any skills you have that are appropriate for the position you are applying for, include if you are already a PSS, PCA or CNA

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EDUCATION

Last Grade Completed *

College

Name & Address of Schools

Majors

Graduated

College, University or Technical/Address

Majors

Graduated

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EMPLOYMENT HISTORY

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Starting with your PRESENT or MOST RECENT EMPLOYER

Name of Employer

Employer Address

Street Address

Address Line 2

City

State / Province

ZIP / Postal Code

Reason for Leaving

Phone

Supervisor Name

Job Title

Employment Dates - From

Employment Dates - To

Pay or Salary - Start

Pay or Salary - Final

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked for this employer.

Name of Employer

Employer Address

Street Address

Address Line 2

City

ZIP / Postal Code

Reason for Leaving

Phone

Supervisor Name

Job Title

Employment Dates - From

Employment Dates - To

Pay or Salary - Start

Pay or Salary - Final

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked for this employer.

Name of Employer

Employer Address

Street Address

Address Line 2

City

State / Province

ZIP / Postal Code

Reason for Leaving

Phone

Supervisor Name

Job Title

Employment Dates - From

Employment Dates - To

Pay or Salary - Start

Pay or Salary - Final

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked for this employer.

If employed, may we contact your present employer?

Yes

No

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PERSONAL REFERENCES (NOT RELATED)

First Name

Last Name

Phone

Known to you # of years?

How do you know?

First Name

Last Name

Phone

Known to you # of years?

How do you know?

First Name

Last Name

Phone

Known to you # of years?

How do you know?

Did you complete this application yourself? *

If not, who assisted?

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READ CAREFULLY

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I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

First Name

Last Name

Date

Thank you for contacting us.
We will get back to you as soon as possible.

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Professional Home Care Specialists, LLC

Our professional skilled home care services help patients recover from illness, injury, or surgery in the privacy and comfort of their own homes.

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Contact Details

Phone
(207) 762-5486

Email
professionalhomecarespecialist@gmail.com

Address
9 Industrial Street, Suite 3 Presque Isle, Maine 04769

Hours
Mon - Fri: 8am - 4pm
Sat - Sun: Closed

Professional Home Care Specialists, LLC

© 2024

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