Franchise 522 Application Form

Application Form

We are an equal opportunity employer interested in caring and reliable applicants who enjoy helping others.

Personal Information

First Name *

Last Name *

Home Phone *

Work Phone

Mobile Phone

Email *

Address 1 *

Address 2

City *

State

Zip *

Section 1 - Skills

Why do you want to be a Comfort Keeper?

Show Plain Text

How did you hear about Comfort Keepers?

Section 2 - General Information

Are you 18 years or older? (required)

Yes No

Do you drive a reliable vehicle and have a valid license and current auto insurance? (required)

Yes No

It is a requirement of the job that you are able to lift 25 pounds. Are you able to do so, along with bending, twisting and reaching? (required)

Yes No

Applicants considered for hire will be subject to a thorough background screening, including criminal background check, motor vehicle check and/or drug screen. Do you agree to this? (required)

Yes No

Caregivers should expect to travel up to 20 miles for client shifts. Do you accept these terms? (required)

Yes No

Do you understand that our starting pay range is up to $17 per hour? (required)

Yes No

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Signature

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