Apply for AB - Torrington (Canaan) - Caregiver

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Summary
Title:AB - Torrington (Canaan) - Caregiver
ID:7545
Location:Canaan, CT
Office:Torrington, CT
Hours Required:N/A
Contact Information
* First Name/Nombre:
* Last Name/Apellido:
Address 1/Direccion:
Address 2/Direccion:
* City/Ciudad:
* State/Estado:
* Zip Code/Codigo Postal:
* Cell Phone/Telefono:
* Email/Correo Electronico:
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Screening Tool - CT (Torrington)
Please complete the below screening questions to help us prioritize and potentially expedite your application review process.
* Have you worked for any of the following agencies in the past?
A&B Homecare Solutions
Modivcare
No Place Like Homecare
CareFinders
Stay at Home Care LLC
Danielcare
Northwest Homecare
None
* What type of case are you willing to work? (select all that apply)
Personal Care
Homemaker
Companion
Live In
* What is your primary mode of transportation?
Personal Vehicle (I drive myself)
Public Transportation (bus, train, etc.)
Uber/Lyft
Walking
* Do you have a valid drivers license?
Yes
No
* What cities/towns would you like to work in?
Torrington
Bristol
Canaan
Norfolk
Litchfield
Winsted
Morris
Bantam
Goshen
* How far are you willing to travel for a case from your home? (select all that apply)
Up to 10 minutes
Up to 20 minutes
Up to 30 minutes
Up to 45 Minutes
Up to 1 hour
Over 1 hour
* Are you willing to work: (select all that apply)
Days
Evenings
Overnights
* When are you available to work?
Only weekdays
Only weekends
Weekdays and Weekends
* Do you have previous experience in homecare/healthcare? (select all that apply)
Homecare
Skilled Nursing
Assisted Living
Family/Friends Care
Hospital Setting
Hospice
None
* Are you applying to work with a specific client? If yes, please include client's first initial and last name.
Yes
No
* Do you have access to technology (ex: smart phone, computer, tablet, etc.) to complete a video interview?
Yes
No
* The starting rate for this role is $16.35, are you comfortable with this base wage?
Yes
No
* To better support our diverse community and ensure effective communication, please share the languages you speak (select all that apply)
English
Spanish
Portuguese
Haitian Creole
Chinese
Russian
Polish
Other (please specify)
* The facts set forth in this application are true and complete to the best of my knowledge. I understand that falsified statements on this application shall be considered sufficient cause for immediate discharge once employed. I hereby authorize investigation of all statements contained herein and release all parties from liability for confirming/denying the information provided.

I understand that neither this application nor any part of consideration for employment establishes an obligation for the company to hire me.

I attest that I am over 18 years of age and am legally eligible to work in the United States of America.
Hiring Age Disclosure
* The caregiver position requires a person to be 18 years or older. Do you meet this requirement?
Yes
No
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:
Female
Male
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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
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
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.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
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
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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