Apply for PH - Huntington (Buffalo) - Caregiver

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Summary
Title:	PH - Huntington (Buffalo) - Caregiver
ID:	7174
Location:	Buffalo
Office:	Huntington, WV
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:
Opt-In Confirmation
	By submitting this application, I consent to receive SMS updates from Modivcare at 8444362761 regarding my employment application. My information will not be shared or used for any other purposes. This application is powered by ApplicantStack on behalf of Modivcare. SMS messages will only be sent by Modivcare and are used exclusively for hiring-related communications when you have subscribed to receive SMS communications.
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Screening Tool - WV (Huntington)

* Previous Experience

* What is your primary mode of transportation?

* What cities/towns would you like to work in? (select all that apply)

	Point Pleasant
	Buffalo
	Nitro
	Hurricane

* How far are you willing to travel for a case from your home? (select all that apply)

* Are you willing to work: (select all that apply)

	Days
	Evenings
	Weekdays
	Weekends

* Have you worked for Panhandle Support Services, or Modivcare in the past?

	Yes
	No

* Are you a client referral? If yes, please include client's first initial and last name. (Ex: J.Doe)

	Yes
	No

* To better support our diverse community and ensure effective communication, please share the languages you speak (select all that apply)

* 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.

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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	Prior Home Care Experience
	Personal/Private Home Care Experience
	Family/Friend Care
	Hospital Setting
	Skilled Nursing
	None

	Vehicle
	Public Transportation
	Uber/Lyft
	Family/Friend Gives Ride
	Walking

	Up to 10 minutes
	Up to 20 minutes
	Up to 30 minutes
	Up to 45 minutes
	Up to 1 hour
	Over 1 hour

	English
	Spanish
	Chinese
	German
	Italian
	French
	Other (please specify)