Application For Employment

Here at My Sacred Home, we believe that hiring the best caregivers leads to greater client satisfaction. If you are a compassionate, hard working and dedicated individual seeking work as a caregiver, home health aide or medical professional, please fill out our following online application form and upload your resume.

Please fill all fields out completely and be sure your resume includes educational history, work experience, professional licenses/certifications and references. If you are having difficulty uploading your resume to us, please fax it to: (316) 440-4851. Only applications with resumes will be considered. Thank you for your interest.

Please Note: This is NOT an offer of employment and ALL information you submit to My Sacred Home is kept strictly confidential.

Personal Information

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Postal Code

* Phone

* Cell Phone:

* Email Address (please double check this for accuracy):

* Position Applying For

* Required Hourly Rate (must be commensurate with position applying for)

* Days Available to Work

* Shift or Hours Preferred

* Are you legally authorized to work in the United States?

Yes

No

* Have you ever been convicted of a felony?

Yes

No

If yes, please explain.

* Will this be your only job?

Yes

No

If answer to the above is "no", please provide a short explanation.

* Are you presently employed?

Yes

No

If yes, may we contact your present employer?

Yes

No

* Do you have easy access to the internet?

Yes

No

* Do you have a valid driver's license?

Yes

No

* Do you own a dependable vehicle?

Yes

No

* Do you have any known allergies?

Yes

No

If answer to above is, "yes" please explain.

* Are you able to lift up to 25 pounds?

Yes

No

* Are you able to cook basic meals?

Yes

No

* Are you willing to work in a home where there are pets?

Yes

No

* Are you willing to work in a home where someone smokes?

Yes

No

* Do you have any experience as a caregiver?

Yes

No

If answer to the above is, "yes" please provide a brief explaination.

* Where did you hear about My Sacred Home?

Employment History

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Salary

Supervisor/Manager

Reason for Leaving

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Salary

Supervisor/Manager

Reason for Leaving

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Salary

Supervisor/Manager

Reason for Leaving

References

Name

Title

Phone

Email Address

Name

Title

Phone

Email Address

Name

Title

Phone

Email Address

Professional Licenses / Certifications

Medical Experience (check all that apply)

Please list all current certifications/licensure(s) and expiration dates

BLS

ACLS

Other

Upload Resume

Please upload a copy of your resume. Use the browse button below to locate your resume file on your compuer then click upload. If you are unable to upload your resume to us, please fax it to: (316) 440-4851. Please remember all applications must be accompanied by a resume to be considered for employment.

Please Read & Initial In The Box Below

* I hereby certify that the information contained in the above online application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or, if hired, dismissal. I also understand that submitting my information in the above online application is in no way an offer of employment from My Sacred Home or any of it's affiliates/clients. I hereby authorize any of the persons or organizations listed in my application to give all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and release all such parties from all liability that may result from furnishing such information to My Sacred Home and it's affiliates/clients. By initialing in the box below, I hereby authorize My Sacred Home and it's affiliates/clients to request and receive such information.

* Indicates Response Required

telemetry	icu	ccu
sicu	micu	acute care
RN	general healthcare	respiratory care