Application for Home Care Providers

We are an equal opportunity employer. We do not discriminate in hiring, promotion, or other employment decisions on the basis of race, sex, color, pregnancy, religion, disability, age, veteran status, sexual orientation, marital status or any other basis protected by law. Equal access to programs, services and employment is available to all persons. I understand that any agreement between Community Bridges and myself is dependant upon the accuracy and truthfulness of the statements made in this application.


Employment History
(Please list the most recent employer first)


Employment Questionnaire

Please list three (3) expierences, skills or abilities relative to this position.

Currently, who makes up your household? Check all that apply.

Do you find yourself to be more of a:

Please descripe your home and any household rules, if applicable, to this position. Include informationabout potential allergens (pets, woodstoves,ect.) and neighborhood inviorment.

Personal or Business References

(Do not include relatives or privously listed supervisors)

Notice: Background information and information pertaining to prior job preformance maybe obtained on all applicants.

In applying for employment with Community Bridges to by fully informed of my previous record and hereby authorize Community Bridges to refernce my background and to obtain any and all relevant information, which may concern me. I heareby release all persons, schools, companies, business, and law enforcement agencies from liability on account of furnishing such information.

I fully understand that any false anwsers or statements, misrepresentation of facts or omissions made by meon this application shall be suffcient cause for denial of employment or discharge and any off of employment is subject to satisfacory reference checks. 

I fully understand that this employment application and any other company documents are not contracts of employment, and that any individual who is hired may voluntarily leave employment upon proper notice, and may be terminated by Community Bridges as authorized by Community Bridges policy and procedure manual. 

I have read the above statement and agree to it's terms.

This application for employment will be considerd active for 1 year from the above date. to be considered for emplyment after that time, you will need to submit another application. 


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