Comfort Keepers #181 Employment Application
Carefully and accurately fill out all fields. When ready, click "Submit" below.
First Name
ex. Nancy
Last Name
ex. Smith
Email Address
ex. name@domain.com
Primary Phone
555-555-5555
Alt. Phone
555-555-5555
Address
suite/Apt# on 2nd line
City, State, Zip
ex. Walla Walla, WA 99216
1. How did you hear about Comfort Keepers?
2. Best Time to Reach You:
3. When can you start? (xx/xx/xx):
4. Are you interested in Full Time?
Yes
No
5. Are you interested in Part Time?
Yes
No
6. Are you interested in PRN (as needed)?
Yes
No
7. Have you ever been convicted of/or plead quilty to a crime other than minor traffic violations?
Yes
No
8. Do you have a valid drivers license?
Yes
No
9. Are you a High School Graduate or have a GED?
Yes
No
