Saving...
An Equal Opportunity Employer
Companions Forever LLC offers equal employment opportunity to all applicants for employment and to all employees regardless of sex, age, race, color, religious creed, sexual orientation, national origin, ancestry, marital status, disability or other characteristic protected by state or federal law.
INSTRUCTION: If you need help filling out this application form please notify the person who gave you this form every reasonable effort will be made to meet your needs in a reasonable amount of time.
Complete all pages of this application
Print clearly. Incomplete not legible applications may not be accepted.
If more space is needed to complete any question, use comments sections on the back.
Application will be active for 90 days and retained for a 12 month period.
This is not an employee contract.
Personal Information
Your Address(es)
Please list your address(es) for the past three years and the years you have resided there:
Your Contact Information
Availability
Click here to view example of multiple schedules
YourSeniorCareService.Com
P: 860-524-8550
F: 860-956-9856
24/7: 860-874-3334
Job Related Skills
YourSeniorCareService.Com
P: 860-524-8550
F: 860-956-9856
24/7: 860-874-3334
Experience.
Education Completed
Personal References
Please provide a minimum of 2 personal references with complete addresses. Don't list former employers or relatives. The individuals you list should know you for at least two years.
pre-employment background check authorization form
I, , understand that as part of the employment process, Companions Forever LLC needs to complete a background check on me regarding:
Criminal record;
Sex and Violent Offenders Record;
Employment Verification;
Education Verification;
License Verification;
Motor Vehicle Records;
Personal/Professional Reference Verification;
Medical Suitability;
request for previous employment verification Request For Previous Employment Verification And Consent
Please confirm your consent to each of the following by adding a check to each checkbox.
I authorize Companions Forever to make inquires of all my employers educational institutions and references connecting my prior employment, the verification of my educational background, and personal character. I further authorize all past employers educational institutions and all other individuals providing references to respond to verbal and written inquires from Companions Forever. I hereby release all such persons ability and damages incurred as a result of tarnishing this information.
I authorize Companions Forever to make inquires of all my employers educational institutions and references connecting my prior employment, the verification of my educational background, and personal character. I further authorize all past employers educational institutions and all other individuals providing references to respond to verbal and written inquires from Companions Forever. I hereby release all such persons and agencies providing such information from any and all claims and damages connected with their release of the requested information.
I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that if I have provided false or misleading statements it shall be grounds for dismissal regardless of when such information is discovered.
I authorize your to investigate all statements and facts provided herein and to contact the employers, and the references I have listed. I hereby authorize each, any, all of them to provide you with any all information concerning me, whether personal or professional and release the company and them from liability for any damages claims or legal actions that I may otherwise be entitle to take as a result from investigation, use or disclosure of such information.
I authorize your company to investigate all statements and facts provided herein and to contact the employers, and the references I have listed. I hereby authorize each, any, all of them to provide you with any all information concerning me, whether personal or professional and release the company and them from liability for any damages claims or legal actions that I may otherwise be entitled to take as a result of investigation, use or disclosure of such information.
APPLICANT PLEASE STOP HERE
View the letter we may send to your previous employer
I certify that the statements made by me are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any Misstatements of fact, I am subject to disqualification, dismissal, or other action pursuant to employment agency policy and procedure, and subject to criminal penalties as prescribed by law.
ADDITION TO EMPLOYMENT APPLICATION
Have you ever pleaded guilty, no contest to or been convicted of any criminal offense involving violence or dishonesty in any state or federal court? NOTE:
You are not required to disclose an arrest, criminal charge, plea or conviction if the records have been erased under Conn.Gen. Stat. Sections 46b-146, 54-76o,or 54-142a.
Records subject to such erasure are records pertaining to a delinquency or that a child was a member of family with service needs, youthful offenders, dismissed or nolled criminal charges, not guilty adjudications, or absolute pardons. Any person whose criminal records have been erased is deemed never to have been arrested and may swear so under oath.
Yes No If yes, give date, location and type of conviction or plea:
Have you ever been subject to any decision imposing disciplinary action by a licensing agency in any state, the District of Columbia, a United States possession or territory or a foreign jurisdiction?
Yes No
If yes, give date, location and type of disciplinary action.
YourSeniorCareService.Com
P: 860-524-8550
F: 860-956-9856
24/7: 860-874-3334
Consent
I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that if I have provided false or misleading statements it shall be grounds for dismissal regardless of when such information is discovered.
I authorize your to investigate all statements and facts provided herein and to contact the employers, and the references I have listed. I hereby authorize each, any, all of them to provide you with any all information concerning me, whether personal or professional and release the company and them from liability for any damages claims or legal actions that I may otherwise be entitle to take as a result from investigation, use or disclosure of such information.
By signing below I acknowledge that I am submitting my application to Companions Forever, LLC and authorizing the pre-employment check and previous employer verification.