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Employment Application

Thank you for your interest in working with Country Care Companions!   Please fill out our online application and we will be in contact with you. 

NOTES:  

1)  The application will not go through if fields marked with * are left blank.  

2)   This online form will not work properly if you use Internet Explorer 9.  Please use an alternate browser or update your version of IE to either version 10 or 11.

3)   If you have difficulty, please send us an email (info@countrycarecompanions.net) and we will send a printable application for you to complete.  

APPLICANT INFO

Name:*
Address:*
Phone:*
-
Best Time to Call:
E-mail:*
Position Applied for:
Desired Hours per week:*
Shift Availability:*
Day of Week Availability:*
Desired Hourly Wage:
Do you have a valid driver's license?*
Driver's License State & Number
Are you authorized to work in the U.S. on an unrestrcted basis?*
Have you ever been convicted of a crime? (Conviction will not necessarily disqualify an applicant for employment)*
If yes, describe dates, charges and penalties:
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EMPLOYMENT HISTORY

Beginning with your most recent employment or volunteer experience and working backward, list all positions held which are necessary for determining your eligibility for employment.

Clearly describe the work duties you personally performed.  You must fill out this application completely even if a resume is being attached.

Upload Resume
Company Name (1):*
Company Address (1):*
Company Phone (1):
-
Start Date (1):
End Date (1):
Position Held (1):*
Wage per hour (1):
Hours worked:*
Responsibilities (1):*
Reason for leaving (1): State if still employed*
Company Name (2):
Company Address (2):
Company Phone (2):
-
Start Date (2):
End Date (2):
Position Held (2):
Wage per hour (2):
Hours worked (2):
Responsibilities (2):
Reason for leaving (2):
Company Name (3):
Company Address (3):
Company Phone (3):
-
Start Date (3):
End Date (3):
Position Held (3):
Wage per hour (3):
Hours worked (3):
Responsibilities (3):
Reason for leaving (3):
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EDUCATION

Did you graduate from High School or receive a GED?*
If no, check the highest grade completed:
High School
School Address:
Dates Attended:
Technical School:
Tech School Address:
Course of Study:
Dates of Attendance:
Certificate Received?
College:
College Address:
Major/Minor:
Years Attended:
Degree Received?
List additional skills, knowledge and abilities you possess:
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PROFESSIONAL REFERENCES

Company Name (1)*
Direct Supervisor (1)*
Phone (1)*
-
Company Name (2)
Direct Supervisor (2)
Phone (2)
-
Company Name (3)
Direct Supervisor (3)
Phone (3)
-

PERSONAL REFERENCES

Name(1)*
Phone(1)*
-
Name(2)
Phone(2)
-
Name(3)
Phone(3)
-
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CERTIFICATION

I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatement of fact, I am subject to disqualification and dismissal and to such other penalties as may be prescribed by law or personnel regulations. All statements made on this application, including employment information, are subject to verification as a condition of employment.

In considering my application for employment, Hands of Hope Colorado may verify all information provided in this application and obtain additional information related to my background.  I authorize all persons, educational institutions, previous employers, credit bureaus and law enforcement agencies to supply information concerning my background.

By submitting this application I certify that I have read, understand and agree to this statement.

Word Verification:
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