Employment Application

Thank you for your interest in joining our team of caregivers.  Please fill out the following form to get started.

Personal Details
We ask for your SSN in part so we can perform a background check prior to employment. By continuing to fill out this form and submitting it, you are agreeing to allow Choice Unlimited LLC gather background information about you. This is a requirement for employment with our company. If you do not consent, do not continue to fill out this form. If you have any questions, please feel free to contact us directly.
If available, please upload a photo or scan of your Social Security Card.
Employment Details
Please enter all times you are available to work, from Monday to Sunday.
Ex: Mon - 1pm to 6pm
Tue - 10am to 7pm
Wed - 6am to 8pm
...and so on.
Please list your education history, including the institution name, and the number of years or degree earned.
Ex: ULM - BA - Business and Finance
ULL - Certificate - Gerontology Studies
If available, please upload a photo or scan of your driver's license.
Employment History
Enter the following information:
Name of employer & name of last supervisor
Job title
Dates of employment
Salary
Address of employer
Phone number?
Reason for leaving (be specific).
List the job duties you held, skills utilized, etc.
Please state if we may contact this employer.
Please list any specific skills you have, including typing speed (if known).
For example, email, office productivity software (like Word, Excel, etc).
Please list at least 2 references, other than relatives and previous employers. Include their name, phone number, email (if known) and how you know the individual.
Disclaimer and Signature

By signing and submitting this form below, you agree to the following statement:

I certify that my answers are true and complete to the best of my knowledge. I hereby give Choice Unlimited LLC permission to verify and obtain background information necessary for hire. I understand that any offers made prior to required and acceptable background checks are subject to change if not permissible. Additionally, I give Choice Unlimited LLC permission to contact me via phone and email to be considered for the position. I also hereby consent to the use of electronic signatures in place of ink-on-paper signatures in my interactions with Choice Unlimited LLC.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in termination.

Please type your full name to electronically sign this employment application. The date of the signature as well as your IP address will automatically be attached to this submission, in accordance with laws regarding electronic signature collection.