Davis In-Home Care Case Study

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EMPLOYMENT APPLICATION for Davis In-Home Care, Inc. Company policy and federal and state law prohibit discrimination due to sex, race, color, gender, religion, national origin/ancestry, citizenship, age, physical or mental disability, medical condition, marital status, sexual orientation, gender identification/orientation, disabled veteran status, Vietnam-era veteran status, or any other characteristic protected by federal or state law. Type or print legibly. Answer all application questions to the best of your knowledge. Material omission or falsification will result in refusal to hire or termination should you become employed. POSITION APPLYING FOR_________________________________ PERSONAL NAME (Last) (First) (Middle) DATE _________________________…show more content…
Experience Discuss any training or experience working with the elderly. What would you like most about working with the elderly? What would you like least about working with the elderly? Skills Please indicate whether you have assisted with or performed the following tasks for seniors. Companionship Bathing Grooming or dressing Incontinence Transfer assist yes yes yes yes yes no no no no no Vacuuming Dusting Clean bathrooms Clean kitchen Bed linen changes yes yes yes yes yes no no no no no Laundry Grocery shopping Cooking Driving Medication reminders yes yes yes yes yes no no no no no Additional Information Times you are available to work Number of hours you would like to work each week? Times you are not available to work Date you can start Desired pay A driver’s license and proof of insurance will be required at time of hire. Do you have dependable transportation? How did you learn of this position? yes Internet no Newspaper Foreign languages: proficiency to speak, read or write? Job Board Agency Current Employee Other Give name of item(s) checked or explain if

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