Employment – Litchfield Hills Chore Service, Inc.

Your Personal Information

How did you learn about us?

Employment Agency

Friend

Walk in

Relative

Other

Your Name

First Middle Last

Your Email Address(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone

Are you currently working?

Yes

May we contact the company you are currently working for or employed by?

Yes

Are you prevented from lawfully working in the country because of Visa or immigration status?

Proof of citizenship or immigration status will be required for you to work for the Chore Service

Yes

On what date would you be available for work?

MM slash DD slash YYYY

Have you been convicted of a felony in the last 7 years:

Conviction will not necessarily disqualify an applicant from employment.

Yes

If yes, please explain:

List Professional, trade, business or civic activities and offices held.

You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status.

References

Give name, address, and phone number of three references who are not related to you. Click + on the right to add rows.

Previous Employment

Your Previous Employers(Required)

Please list your previous employers, the dates you worked and the position you held. Click on + sign to add additional rows.

Employer

Telephone

Address

Dates Worked:

Job Title:

Work Performed:

Reason for Leaving:

Please describe any work with the elderly or disabled -

If not previously to covered under work experience or any other skills or qualifications that you feel are relevant to working with elderly and disabled at home:

Volunteer Experience:

Upload Your Resume

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Chore Workers help older and disabled people. Because of the nature of this work, we respectfully request that you:(Required)

-Accept only the work that you can perform comfortably.
-Be prompt, courteous, clean and sober. Call your client if you cannot make your appointment.
-Respect your client's confidentiality as well as his or her needs.
-Refrain from bringing politics or religion to your work.
-Notify us immediately if you are unable to do the work, either temporarily or permanently.
-Bring any concerns about your work to the attention of the Core Service office.

Time sheets: We ask you to submit time sheets within one week of work performed.

I have read and agree to comply with the above guidelines. I certify that the answers given herein are true and complete to the best of my knowledge.

Please read the items below very carefully and check the box to confirm you have read them.(Required)

Note: Chore workers do not provide personal care or medical assistance. Workers may, with the client's permission, drive the Chore Service clients in the client's car.

I agree that I will not provide personal care or medical assistance to my clients.

I understand that the Chore Service will be performing police and background checks. I give permission to the Chore Service to ask my previous contractors, employers or volunteer supervisors for references.(Required)

I agree.

Name

First Last

Date

MM slash DD slash YYYY

Apply to work with us

Your Personal Information

Previous Employment