Angel Care - Home Health Services

Specializing in 24 hour in home care, consisting of both personal care assistance and homemaker service.

Be assured that all our staff have been through extensive training in all areas of CPR, Homemaking & Personal Care Assistance.

Your personal and medical records will be treated with strict confidentiality by our entire professional staff.

We provide the highest standard of in-home living assistance, keeping intact our clients independence and personal dignity.

Employment Application

Click here to download the printable employment application or you may fill out the online application below. Personal Care Attendant Requirements High School Diploma or Equivalent Current Drivers License and Insurance Social Security Card and/or Resident Alien Card TB Test CPR / 1st Aid Certification Criminal Background Check Physical References Training for PCA Certification Personal Care Attendant Experience Preferred
Application Information
Last Name:
First Name:
M.I.:
Date:
Street Address:
Apartment #
City:
State:
Zip:
Phone:
Email Address:
Date Available:
Social Security #:
Date of Birth:
Position Applied:
Desired Salary:
Are you a Citizen of the United States:	Yes No
If no, are you authorized to work in the U.S?	Yes No
Have you ever work for this company?	Yes No
If so, when?
Have you ever been convicted of a felony?	Yes No
If yes, explain?

Education
High School:
Address:
From:
To:
Did you graduate?	Yes No
Degree?

College:
Address:
From:
To:
Did you graduate?	Yes No
Degree?

Other:
Address:
From:
To:
Did you graduate?	Yes No
Degree?

References
Please list three professional references.
Full Name:
Relationship:
Company:
Phone:
Address:

Full Name:
Relationship:
Company:
Phone:
Address:

Full Name:
Relationship:
Company:
Phone:
Address:

Previous Employment
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving?
May we contact your previous supervisor for a reference?	Yes No

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving?
May we contact your previous supervisor for a reference?	Yes No

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason for leaving?
May we contact your previous supervisor for a reference?	Yes No

Military Service
Branch:
From:
To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:

Disclaimer & Signature By submitting this application I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.