Application for Cargeivers (LPN/RN/CNA/HHA)

1. Personal Information:

Residential Address
Contact Details
Date of birth
Male Female
US CitizenNot a US Citizen

2. Education and Training:

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3. Licensure and Certifications:

  
  
  
  
  
  
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Any other relevant licenses or certifications (e.g., IV certification, medication administration, etc.)

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4. Work Experience:

List previous employment positions (most recent first)


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From ______/______/________Until ______/______/________
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Yes ____ No _____

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From ______/______/________Until ______/______/________
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Yes ____ No _____

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From ______/______/________Until ______/______/________
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5. Skills and Abilities:

Please rate your skills and Abilities by choosing a checkbox for each of the following:

6. References:

Ideally, include references from supervisors or instructors who can attest to your nursing skills and work ethic:

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7. Additional Information:

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8. Background Check Policy Disclaimer for New Jersey Home Health Aid (2023):

a. Sunshine Home Care is committed to ensuring the safety and well-being of our clients and maintaining the highest standards of care. As part of our employment process for home health aids, we conduct background checks to assess the suitability and qualifications of potential employees. This policy is in accordance with the guidelines provided by the New Jersey Consumer Affairs and other applicable state and federal laws.

b. Consent for Background Check: By submitting an application for employment with Sunshine Home Care , the applicant agrees to consent to a background check. This includes, but is not limited to, verification of educational credentials, employment history, criminal records, and any other relevant information necessary to evaluate their eligibility for employment.

c. Background Check Process: The background check will be performed by a third-party screening service or agency authorized by Sunshine Home Care . The screening may include, but is not limited to, criminal records checks, sex offender registry checks, employment verification, educational verification, and professional license verification.

d. Confidentiality and Privacy: All personal information provided by the applicant will be treated as confidential and handled in accordance with applicable privacy laws and regulations. Access to this information will be restricted to individuals involved in the hiring process.

e. Employment Eligibility: Employment decisions will be made based on the results of the background check in compliance with applicable laws and regulations. A criminal record or other information revealed by the background check will not automatically disqualify an applicant from employment unless it is determined to be directly relevant to the position applied for.

f. Adverse Action Process: In the event that adverse information is revealed through the background check, the applicant will be provided with a copy of the report and a written explanation of their rights under the Fair Credit Reporting Act (FCRA). The applicant will have an opportunity to dispute the accuracy or completeness of the report before any final employment decisions are made.

g. Compliance with Laws: Sunshine Home Care is committed to complying with all relevant federal, state, and local laws, including the New Jersey Consumer Affairs regulations, and will ensure that all background checks are conducted in accordance with these laws.

h. Disclaimer: Sunshine Home Care assumes no liability or responsibility for the accuracy, completeness, or timeliness of the information obtained through the background check process. The organization shall not be held liable for any adverse employment decisions made based on the background check results, provided such decisions comply with applicable laws and regulations.

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9. Your Certification and Signature

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

____________________________________________Date ______/_________/_________
Applicant Signature and Date.

Mail to Sunshine Home Care
58 Route 46
Suite 223
Mt. Olive, NJ 07828

Thank You for your application and your interest to join our team! We look forward to meeting you!

>Mount Olive, NJ USA Sunshine Home Care 732-510-8883