Thank you for your interest in working for our agency.

Please submit the application below to be considered for a position as a caregiver.

Applicant Information:
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Match Criteria:
Indicate caregiver's skills and limitations. These will be used for matching the caregiver with clients.

General

Transfers

Pets

Education & Training:
Certifications and Credentials:
Please check all that apply, and enter the expiration date and any notes as applicable.
Active Type Expiration Date Notes
Car Insurance
Chest X-Ray
CNA License
CPR Certification
Driver's License
First Aid Certification
HHA Certification
LVN/LPN Certification
Passport
Performance Evaluation
Registered Nurse
State ID Card
Tuberculosis Test

+ Add Additional Certification or Credential

Employment History:
Please provide your most recent positions of employment.

+ Add Additional Employer

Professional References:
Please provide professional references.

+ Add Additional Reference

Additional Information:
Disclaimer:
“I understand that this application is not a promise of employment. I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of wages. If accepted for employment, I agree to abide by all policies/procedures of Kyle’s Care at Home and state/federal law. Illinois is an “at will” employment state, thus I understand that I have the right to terminate my employment at any time with or without notice, and the Agency has the same right. I also understand and agree that no representative of this Agency has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by the Owners. I authorize investigation of all statements contained herein and the references and employers listed above to give you and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information. I understand that employment by Kyle’s Care at Home and the signing of this statement does not constitute a contract of employment or guarantee employment for a specific length of time. I understand that any and all information I may see, handle, and/or transact in any manner is the property of Kyle’s Care at Home and/or the client being served and shall be treated as “Confidential” information. Any disclosure of this information to any other than Kyle’s Care and/or the client will be considered a breach of statement and may result in termination. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I certify that the facts contained in this application are true and complete to the best of my knowledge; and information has neither been omitted nor misrepresented. I understand that, if employed, falsified statements on this application shall be grounds for dismissal.”
Signature:

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