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Summary
Title:	Caregiver for Seniors PART TIME SHIFTS
ID:	1006
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Opt-In Confirmation
	By submitting this application, I consent to receive SMS updates from Home Instead 870 at 8335571302 regarding my employment application. My information will not be shared or used for any other purposes. This application is powered by ApplicantStack on behalf of Home Instead 870. SMS messages will only be sent by Home Instead 870 and are used exclusively for hiring-related communications when you have subscribed to receive SMS communications.
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APPLICANT NOTE

CNG Holdings, LLC is an independently owned and operated Home Instead® franchise 1032 Washington Blvd., Williamsport, PA 17701 (570) 244-2224.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

	I'm new to caregiving
	Less than 6 months
	6 - 11 months
	1 year
	2-3 years
	4 years or more

	None of these
	Williamsport
	Muncy
	Danville
	Bloomsburg
	Jersey Shore

	Less then 15
	15-20
	20-30
	30+

	Yes
	No

	Yes
	No

	Yes
	No

	Yes
	No