Application for Employment

Arise Cares – Apply Online

First, tell us some basics about how to contact you.

Full Name

Are you at least 18 years old?

Yes

Referral Source

Who referred you to us? (select all that apply)

Facebook Indeed CraigslistOther Internet AdHandshakeCollege CampusProfessorFriend/Employee/ClientBillboardPosterNewspaper Walk In

Further Referral Source Info

College Campus

Professor

Friend/Employee/Client:

How do we reach you?

Home Phone

Cell Phone

Where do you live right now?

Street

City

State / Province

ZIP / Postal Code

Is this your permanent address?

Yes

Permanent Address

Street

City

State / Province

ZIP / Postal Code

Arise Cares in an Equal Opportunity Employer. We do not discriminate based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability or genetic information.

Next, tell us what work you would like to do at Arise Cares

Desired Employment

Availability

Full Time

Part Time

CLICK HERE to read more about available positions and job descriptions.

Position

Desired Annual Salary

For example: 30000 (dollar signs, commas, or periods not allowed)

Desired Location

Preferred Start Date

MM/DD/YYYY

Current/Previous Employment

I am currently employed I was previously employed (not currently)I have never been employed

Employee Skills Inventory

I have experience caring for a person with:

ADD/ADHDAIDSAlzheimer’sAutismBlindnessCerebral PalsyDiabetesDown SyndromeExtreme BehaviorsHIVMental IllnessMultiple SclerosisNonverbalRespiratory ConditionsRetardationSeizuresStroke

I have experience helping a person with mobility:

Working with wheel chairsWorking with walkersWorking with crutchesWorking with canesTransferring a personTransfer a person with 2 assistUsing a transfer beltUsing a Pal liftUsing a Hoyer liftPT/OT specific exercisesHand/wrist braces/splintsAFOs- foot bracesTLSOs- chest bracesActive range of motionPassive range of motion

I have experience helping a person with basic needs:

Feeding an adultFeeding a childFeeding a person w/swallowing problemsFeeding a person using feeding tubeOral meds (pills)Oral meds (liquids)Rectal medsGiving a showerGiving a bathGiving a sponge bathChanging diapers (infant)Changing diapers (adult)Working with a catheterMaking an occupied bedChanging bandagesCleaning woundsTopical ointmentsGiving shotsEye drops/salveEar drops

I have experience with respiratory equipment

Working with oxygenO2 concentratorNebulizersPulse oximeterChanged O2 tanks/regulators

I have experience helping a person with Domestic Tasks

Cooking mealsCleaning equipmentGrocery shoppingCleaning a houseCold sterilization

I also have experience helping a person with:

GlucometersBrushing TherapyJoint compressions

Now we’d like to know about your recent work experience.

Most recent employment

Employer Name

Employer Phone Number

Employer City

Employer State

Start Date

MM/DD/YYYY

End Date

MM/DD/YYYY

Reason for Leaving

Job Title

Weekly Salary

For example: 30000 (dollar signs, commas, or periods not allowed)

Description of Work

May we Contact your Supervisor?

YesNo

Supervisor Information

Name

Phone Number

There’s more to my employment history

YesNo

Previous or Secondary Employer

Employer Name

Employer Phone Number

Employer City

Employer State

I currently work here

YesNo

Start Date

MM/DD/YYYY

End Date

MM/DD/YYYY

Reason for Leaving

Job Title

Weekly Salary

For example: 30000 (dollar signs, commas, or periods not allowed)

Description of Work

May we Contact your Supervisor?

YesNo

Supervisor Information

Name

Phone Number

I’ve had at least one more employment from the last 10 years.

YesNo

Third Current/Previous Employer

Employer Name

Employer Phone Number

Employer City

Employer State

I currently work here

YesNo

Start Date

MM/DD/YYYY

End Date

MM/DD/YYYY

Reason for Leaving

Job Title

Weekly Salary

For example: 30000 (dollar signs, commas, or periods not allowed)

Description of Work

May we Contact your Supervisor?

YesNo

Supervisor Information

Name

Phone Number

Please share some information about your education

Check boxes for each level of education you started or completed.

High SchoolCollege/UniversityTrade/Business SchoolSpecial Training, Skills, or Certifications

High School

School Name

School Location (i.e. City, State)

Did you graduate?

YesNoCurrently Attending

Do you have a GED/High School Equivalency Certificate?

YesNo

List any Sports, Activities, or Awards earned during High School

College/University

Undergraduate College/University Name

School Location (i.e. City, State)

Did you earn a degree?

YesNoCurrently Attending

Last year attended

YYYY

Did you attend Graduate School?

YesNoCurrently Attending

Post-Baccalaureate University Name

School Location (i.e. City, State)

Last year attended

YYYY

Areas of Study

Graduate and Undergraduate degree(s) earned.

e.g. B.S in Astronautical Engineering

List any Sports, Activities, or Awards earned during College

Trade/Business School

Name of Institution

Institution Location (i.e City, State)

Did you earn a degree/certificate/complete the program?

YesNoCurrently Attending

Last year attended

YYYY

Area(s) of Study

e.g Cosmetology

Special Training, Skills, or Certifications

List Special Training, Skills, or Certifications

Who can we reach out to for verification of the information in your application?

List the names of 1-3 persons you are not related to, whom you have known for at least one year.

Reference 1

Name

Years Acquainted

What company or organization connects you?

Phone Number

Address

I have another reference

YesNo

Reference 2

Name

Years Acquainted

What company or organization connects you?

Phone Number

Address

I have another reference

YesNo

Reference 3

Name

Years Acquainted

What company or organization connects you?

Phone Number

Address

Final step!

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and of all references and employers listed above to give any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also acknowledge that my employment may be terminated, or any offer or acceptance of
employment withdrawn, at any time, with or without cause, and with or without prior notice at
the option of the company or myself.

I certify that I have read the above statements

Typing your name in the Signature box exactly as shown below constitutes a legal signature confirming that you acknowledge and agree to the statements above.

Electronic Signature:

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