Apply for Caregiver- Morehead City, NC

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Summary
Title:Caregiver- Morehead City, NC
ID:1092
Location:Morehead City, NC
Department:Caregiver
Salary Range:$15.00-$17.00
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Application for Employment

Equal Opportunity Employer: It is our policy to abide by all Federal and State laws prohibiting employment discrimination solely on the basis of a person’s race, creed national origin, age, sex, marital status, or physical disability.



PERSONAL BACKGROUND
Yes   No
Yes   No
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EMPLOYMENT DESIRED
Full Time   Part Time   Seasonal
Yes   No
Yes   No
EDUCATION/SKILLS

School 1

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School 2

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School 3

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School 4

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School 5

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EMPLOYMENT DATA

(Beginning with latest employer. Please include military service)

Employer 1

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Employer 2

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Employer 3

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Employer 4

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Employer 5

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WORK AVAILABILITY
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Saturday   Sunday


Please fill out the days and times you are available to work

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Employee acknowledges that they will be expected to be available to work during the days and times they have outlined above. Failure to do so may result in termination. Management agrees not to schedule employee during days and times not marked as available unless specific authorization from the employee has been given.

REFERENCES

List three adults not related to you who have personal knowledge of your work ethic, experience and abilities. At least one must be a previous employer or direct supervisor

Reference 1

Reference 2

Reference 3
APPLICANT'S ACKNOWLEDGEMENT AND AUTHORIZATION

This application will remain on active file for 1 year. If I am hired, this form will be transferred to my individual personnel file

I am required to sign a statement acknowledging my understanding of and willingness to comply with the company’s Drug Free Workplace Policy.

If my application for employment is accepted and I am hired, I agree to abide by all of the policies and procedures set forth by Seniors Choosing to Live at Home Management Services LLC.

Prior to my being offered employment, I understand that I must provide a North Carolina criminal record check (or national criminal record check if I have lived in North Carolina for less than 5 years) and verification of a PPD (tuberculosis).

I authorize to my current and prior employers, educational institution, and persons or organizations named in this application (or accompanying resume) to release any information they have about me to Seniors Choosing to Live at Home Management Services LLC.

Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including dismissal from employment of discovered at a later date.

My employment is not guaranteed for any term, and my employment may be terminated by Seniors Choosing to Live at Home Management Services LLC. At any time, for any reason. No management official is authorized to make any oral or written assurance or promise of continued employment.

I have read and understand the Applicant’s Acknowledgement and Authorization.

2023 - Voluntary Self-Identification of Disability CC-305

Voluntary Self-Identification of Disability

Form CC-305
Page 1 of 1
OMB Control Number 1250-0005
Expires 04/30/2026
Name:
Employee ID:
(if applicable)
Date:

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
  • Alcohol or other substance use disorder (not currently using drugs illegally)
  • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
  • Blind or low vision
  • Cancer (past or present)
  • Cardiovascular or heart disease
  • Celiac disease
  • Cerebral palsy
  • Deaf or serious difficulty hearing
  • Diabetes
  • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
  • Epilepsy or other seizure disorder
  • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
  • Intellectual or developmental disability
  • Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
  • Missing limbs or partially missing limbs
  • Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
  • Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
  • Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
  • Partial or complete paralysis (any cause)
  • Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
  • Short stature (dwarfism)
  • Traumatic brain injury

Please check one of the boxes below:

Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
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Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
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Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
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Veteran Status: (Please check all that apply)
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
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A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
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