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Employment Application

We Are Hiring Compassionate Caregivers

Thank you for your interest in joining Comfort Care Senior Care. We are committed to providing professional, dependable, and compassionate non-medical care to seniors in our community.

Please complete this application in full. Incomplete applications may not be considered.

PERSONAL INFORMATION

First Name *

Last Name *

Date of birth *

Phone *

Email *

Address *

Street Address

Country

Country

State

City

Postal Code

POSITION DETAILS :

Position Applying For Options:

Employment Type

Available Start Date

Availability

Days

Nights

Weekends

Holidays

Live-In

TRANSPORTATION

Reliable Transportation

I have reliable transportation

Driver’s License Number

State Issued

I Carry Valid auto insurance

I Carry Valid auto insurance

BACKGROUND & LEGAL

Have you ever been convicted of a felony or misdemeanor?

YES

NO

Please explain if, Yes

Screening Acknowledgments

I consent to criminal background screening

I consent to drug screening if required

I understand employment is at-will

I understand Alabama mandatory reporting laws

Employer 1 — Company

Employer 1 — Job Title

Employer 1 — Employment Dates

Employer 1 — Supervisor

Employer 2 — Company

Employer 2 — Job Title

Employer 2 — Employment Dates

Employer 2 — Supervisor

Employer 3 — Company

Employer 3 — Job Title

Employer 3 — Employment Dates

Employer 3 — Supervisor

EMPLOYMENT HISTORY

Reason for leaving

Reason for leaving job 2

Reason for leaving job 3

Caregiving Settings Experience

Private-duty home care

Assisted living

Hospital

Dementia/ Alzheimer's care

Home care agency

Nursing facility

Family caregiving

Describe your caregiver experience

Why do you want to work in senior care?

REFERENCES

Reference 1 Name

Relationship/Company

Reference 1 Phone

Reference 1 Email

Reference 1 yrs known

Reference 2 Name

Relationship/Company2

Reference 2 Phone

Reference 2 Email

Reference 2 yrs known

Reference 3 Name

Relationship/Company3

Reference 3 Phone

Reference 3 Email

Reference 3 yrs known

Applicant Certification

I certify that the information provided is accurate and authorize Comfort Care Senior Care to contact me about my employment application.

Years of Caregiving Experience

CNA Certification Status

Select an option

Resume Upload (Optional)

Click to upload

Upload your resume. Do not include Social Security numbers or identity documents.

Certifications Upload (Optional)

Click to upload

Upload CNA, CPR or first-aid certificates if available.

Desired Hours Per Week

By checking this box, I consent to receive non-marketing text messages from Comfort Care Senior Care about Joining our team. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others .from Comfort Care Senior Care at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

Comfort Care Senior Care is an Equal Opportunity Employer.

All employment is contingent upon background verification and compliance with Alabama state regulations.

Contact Us

info@ comfortcareinhomeseniorcare.com

256.337.5714

912 Winchester Rd Ste 1 Huntsville,AL 35811