Pre-Screening Questionnaire

Do you have the required license/certification?

Years as a Home Care Aide

Valid driver’s license?

Willing to proceed with background investigation?

Willing to complete felony background check?

Smartphone with internet access?

Commit to 40 hours with rotating shifts?

How did you hear about this job posting?

Friends/relatives at our company?

Legally authorized to work in the U.S.?

Government Forms (Download & Complete)

These must remain in their official format. Download, complete, and save a copy. You’ll upload them later or submit via your onboarding portal.

Download I-9 (Employment Eligibility) Download W-4 (Federal Withholding) Download W-4MN (Minnesota Withholding) Download MN Employee Notice

Application for Employment — Personal Information

Personal Details

Full Name (First Middle Last)

Email

Present Address (Street, City, State, Zip)

Home Phone

Cell Phone

Lived outside Minnesota within last 5 years?

Legally entitled to work in the U.S.?

At least 18 years of age?

Emergency Contact

Name

Phone

Relationship

Transportation

Current Driver’s License?

Do you currently have a car?

Prior Application & Background

Applied here before?

If yes: Where?

If yes: When?

Convicted of a crime (other than minor traffic)?

If yes, please explain (jurisdiction, date, disposition)

Professional Licenses / Certifications

Any licenses/certifications/registrations?

License/Certificate/Registration #

Type

State Issued

Expiration Date

Status

References (Work Related)

Name

Phone

Address

Position

Name

Phone

Address

Position

Name

Phone

Address

Position

Education

High School — Name & Location

High School — Years Attended

High School — Graduated?

High School — Degree/Certificate

College — Name & Location

College — Years Attended

College — Graduated?

College — Degree/Certificate

Additional Training — Name & Location

Additional Training — Years Attended

Additional Training — Degree/Certificate

Upload Completed Government Forms

Attach your completed government forms (PDF preferred). You may add multiple files.

Upload files (PDF, JPG, PNG)

New Employee Application & Policy Acknowledgments

Pre-Screening Questionnaire

Government Forms (Download & Complete)

Application for Employment — Personal Information

Personal Details

Emergency Contact

Transportation

Prior Application & Background

Professional Licenses / Certifications

References (Work Related)

Education

Upload Completed Government Forms

Location

Hours

Contact