Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Desired Role *

Pick the role(s) you are applying for

Certified Nursing Assistant

Home Health Aid

Home Maker

Licensed Practical Nurse

Registered Nurse

Education & Training *

Pick your most recent educational experience

High School

College

Match Criteria *

Please select checkboxes that match your skills and preferences.

Dementia Experience

Hospice Experience

Incontinence Experience

Insured Automobile

Live-In Shifts OK

OK with Client Smoking

Gait Belt Experience

Hoyer Lift Experience

OK with Cats

OK with Dogs

Certifications & Credentials *

Please check any of these that fall under your active certifications and credentials.

Car Insurance

Chest X-Ray

CNA License

CPR Certification

Driver's License

First Aid Certification

Health Physical

Hepatitis B

HHA Certification

Licensed Practical Nurse

LVN/LPN Certification

Occupational Therapist

Passport

Performance Evaluation

Physical Therapist

Registered Nurse

Social Worker

State ID Card

Tuberculosis Test

Do you authorize Great Comfort Care to contact any schools, former places of employment, and/or persons who may aid Great Comfort Care in determining your suitability for employment? *

Yes

No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment. *

Yes

No

Can you travel if the job requires it and do you have reliable transportation to work? *

Yes

No

We cannot guarantee a set number of hours due to the nature of our business. Is this acceptable?Radio 1 *

Yes

No

We are required to conduct background checks on criminal records, driving records, social security verification, and other areas. Indicate below if you consent to these checks. Do you consent to background checks? *

Yes

No