Employment Application - Hoop Cares LLC

Applicant Information

Full Name *

Date

Address *

City *

State *

Zip *

Phone Number *

Email Address *

Date Available to Start *

Desired Position *

Type of Employment *

Full-Time Part-Time PRN

Are you legally eligible to work in the U.S.? *

Yes No

Do you have a valid driver's license? *

Yes No

Do you have reliable transportation? *

Yes No

Employment History

Most recent first. Employer 1 is required. Fill in Employers 2 and 3 if applicable.

Employer 1 *

Employer Name *

Position Held *

Start Date *

End Date *

Reason for Leaving *

Supervisor Name & Phone *

Employer 2

Employer Name

Position Held

Start Date

End Date

Reason for Leaving

Supervisor Name & Phone

Employer 3

Employer Name

Position Held

Start Date

End Date

Reason for Leaving

Supervisor Name & Phone

Education

High School / GED *

College / Other Training

Certifications (CNA, CPR, etc.) *

References

Professional preferred. Both references are required.

Reference 1 *

Name *

Phone *

Relationship *

Reference 2 *

Name *

Phone *

Relationship *

Additional Information

Why do you want to work at Hoop Cares LLC? *

Do you have any experience with elderly care, dementia, or transportation services? *

Yes No

If yes, please describe:

Consent for Background Check

Signature *

Draw

Type

Date

Disclaimer and Signature

Signature *

Draw

Type

Date