Application Form

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.

Personal Information

Section 1 - General Information

Section 2 - Education & Certification

Section 3 - 1st Most Recent Employer

(Numeric Answer Only)

Section 4 - 2nd Most Recent Employer

Section 5 - 3rd Most Recent Employer

Section 6 - Personal Reference 1

Section 7 - Personal Reference 2

Section 8 - Personal Reference 3

Section 9 - Agreement

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.  I also hereby authorize Comfort Keepers to request and receive from all prior employers within one year of the date of this application, all pertinent information concerning my prior employment, including the reasons for termination.