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"It is in your hands to create a better world for all who live in it"

Employment Application

Helpful Hands Companion Services, LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Application Information

First Name

Last Name

Today's Date

Address

City

Zip Code

Phone

Email

Employment Position

Hours or shift available for work?

Stare date and days available for work?

Are you available for overtime?

How did you here about position?

Personal Information

If yes, When?

If yes, state name and relationship

What document can you provide of citizenship?

If yes, please describe accommodations required

If yes, what crime, when, where and disposition of case

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Job Skills / Qualifications

Please list the skills and qualifications you possess for position which you are applying for:

(Note: Helpful Hands Companion Services, LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional).

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