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Aquinas Healthcare Application for Employment

323 Main St Lower Level
Chatham, NJ 07928
Aquinas Healthcare takes affirmative action to select the best-qualified applicants without regard to race, color, creed, national origin, gender, sexual preference, age, religion, or disability where accommodations will not impose an undue hardship on the agency. Our Company is an equal opportunity employer.

Dear Applicant:

Home care does make a difference in the lives of the neighbors we serve by making it possible for them to stay at home during difficult times, and live independent lives with dignity. We know that providing care to people in their home is both a professionally challenging and personally rewarding career. If you are chosen to become a new member of our team, you too will play an important role in people's lives and our community.

The work here at Aquinas Healthcare requires a person who is honest, dependable, and competent and gets satisfaction from helping others. We know this because that is what our clients tell us they expect, and what has made our staff successful.

If you are new to home care or an experienced care provider, we thank you for considering Aquinas Healthcare and its mission of caring to improve people's lives.

Thank you, Aquinas Healthcare Management.

Instructions

Please make sure you fill out the following application form completely. Answer all questions and sign and date the application form at the end. Incomplete or wrong information can cause a delay in processing your application. Part of the selection process will include a personal interview, reference and criminal history background check, health exam, and gathering required citizenship documentation.

I. PERSONAL INFORMATION

Do you Drive?
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Please check YES or NO for each question

Are you 18 years old or older?
Do you currently have a valid professional license or occupational certification?
Do you have your own transportation? (Direct Care staff will be required to travel throughout all of our service area)
Are you legally eligible for employment in the United States? If NO, what is your status?
Do you have any relatives working for our Company?

II. POSITION DESIRED

Check the box for the position you are applying for
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Are you available for (check all that apply to you)

III. EDUCATION AND TRAINING

Check the highest grade you have completed:
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List the Occupational, State, Number, and Expiration Date of the certificate or license you have

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Check the following software you can use
Check the special skills you are experienced in

IV. EMPLOYMENT HISTORY

I, hereby authorize Aquinas Healthcare to request and receive from all prior employers within one year of the date of this application, any and all pertinent information concerning my prior employment and its termination, including the reasons for such termination.

List your three (3) most recent employers below, starting with your current or most recent job.

Date of Employment:

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Date of Employment:

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Date of Employment:

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V. PERSONAL REFERENCES (No family or close friends})

Name
Address
Phone
 

VI. GENERAL INFORMATION

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This application will be kept on file for ninety days (90) from the date completed. After this time a new application must be completed for consideration of employment.

AQUINAS HEALTHCARE USE ONLY

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