Employment Application

Home Health Aide Application

Complete this application for consideration for full-time, part-time, or PRN caregiver opportunities with My Gentle Touch LLC Homecare.

Important Applicant Notice

Positions involving direct care may require database reviews and a criminal records check, including fingerprint impressions, before employment can be finalized. Additional screening and onboarding documents may be requested later in the hiring process.

Do not enter Social Security numbers, banking information, or upload identity documents through this application.

1. Applicant Information

Full Name Preferred Name Phone Email Street Address City ZIP Code Preferred Contact Method Earliest Start Date

2. Position & Availability

Position: Home Health Aide

Full-Time Part-Time PRN

Describe Your Availability Are you legally authorized to work in the United States?

3. Caregiving Experience

Years of Caregiving Experience Primary Experience Setting

Describe Your Caregiving Experience

Select areas where you have experience:

4. Certifications & Transportation

Current certifications or credentials:

License / Certification Number Credential Expiration Date Do you have reliable transportation? Do you hold a valid driver's license?

5. Professional References

Please provide at least two professional or caregiving references.

Reference 1

Name Phone Email Relationship

Reference 2

Name Phone Email Relationship

6. Screening Notice & Applicant Certification

Applicants under final consideration for a direct-care position may be subject to required state and national database reviews and a criminal records check. If applicable, My Gentle Touch LLC Homecare will provide the forms and instructions required for fingerprinting and related screening at the appropriate stage.

This application does not authorize a third-party consumer report or background report. Any additional authorization required for a separate background-check provider will be handled separately.

Applicant Signature (type full legal name) Date