We look forward to having you on our Loving Hands of Nevada team. Before filling out out this application be sure to read about the benefits of joining our working family. We want you to feel you're a good fit as we're not your average service. Within 2 days of receiving your application we will get in touch with you requesting to set up an interview or notify you will not be eligible for hire at this time. Should that be the case you're always free to re-apply up to 3 times a year.

 

All fields marked with red asterisk • are required

* First Name ______________________  Middle Initial ____  * Last Name ________________________
* Current Street Address _________________________________________________________________
* City _____________________________  * Zip Code ___________________
* Best Phone Contact   ◻︎ Mobile  ◻︎ Home
* E-mail Address _________________________________________________________________________

Work Availability
Specify how many hours you’re available on each day of every week; input the number only; for example 8 hours on Monday. The amount of work we can assign depends on your flexibility...
Monday  Hours: ________  Times: ___________________________
Tuesday  Hours: ________  Times: ___________________________
Wednesday  Hours: _____  Times: ___________________________
Thursday  Hours: _______  Times: ___________________________
Friday  Hours: __________  Times: ___________________________
Saturday  Hours: _______  Times: ___________________________
Sunday  Hours: ________  Times: ___________________________

What areas would you prefer to work in? (Please check all areas you would consider. The amount of work we can assign depends on your flexibility.)
Preferences:
◻︎ No Preference ◻︎ Henderson ◻︎ The Lakes ◻︎ Las Vegas ◻︎ North Las Vegas ◻︎ Aliante  ◻︎ Summerlin
◻︎ Sunrise Manor ◻︎ Spring Valley ◻︎ Paradise ◻︎ Centennial Hills  ◻︎ Boulder City ◻︎ Enterprise

Date available for work:
Month  _________  Day _______  Year   20_____

Certifications & Licenses

Professional Licenses: ______________________________________________________
Certifications: _____________________________________________________________

Educational Background
High School ______________________________________
City ________________________________  State _______
Graduated? ◻︎ Yes  Year _______   ◻︎  No  GED? ◻︎ Yes  Year _______   ◻︎  No
College _________________________________________
City ________________________________  State _______
Graduated? ◻︎ Yes  Year _______   ◻︎  No
Major/Degree _________________
Nursing School_________________________________________
City ________________________________  State _______
Graduated? ◻︎ Yes  Year _______   ◻︎  No
Technical Training_________________________________________
City ________________________________  State _______
Graduated? ◻︎ Yes  Year _______   ◻︎  No

Employment History
Starting with your most recent position, list your 3 most recent.

Date Started _________________________  Date Ended __________________________
Employer name ___________________________________________________________
Employer Address _________________________________________________________
Employer Phone ____________________  Supervisor ____________________________
Job Title _________________________________________________________________
Duties ___________________________________________________________________
Reason For Leaving  ________________________________________________________

Date Started _________________________  Date Ended __________________________
Employer name ___________________________________________________________
Employer Address _________________________________________________________
Employer Phone ____________________  Supervisor ____________________________
Job Title _________________________________________________________________
Duties ___________________________________________________________________
Reason For Leaving  ________________________________________________________

Date Started _________________________  Date Ended __________________________
Employer name ___________________________________________________________
Employer Address _________________________________________________________
Employer Phone ____________________  Supervisor ____________________________
Job Title _________________________________________________________________
Duties ___________________________________________________________________
Reason For Leaving  ________________________________________________________

 

May we call your employers? ◻︎ Yes  ◻︎  No
If no please explain ________________________________________________________
 ________________________________________________________________________
________________________________________________________________________

If none of the employment listed above is related to medical, hospital, or home care experience please describe your previous experience  (if any) in one or more of these areas
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Additional Qualifying Information

Have you been fired in the last ten years? ◻︎ Yes  ◻︎  No
if yes, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________

Have you been employed or attended school using any other name?  ◻︎ Yes  ◻︎  No

if yes, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________

Do you have the legal right to be employed in the United States?  ◻︎ Yes  ◻︎  No
If  hired, you will be required to provide identification to prove eligibility for employment
Have you ever been convicted, plead guilty or no contest, or forfeited bond on bail for any crime other than traffic violations? ◻︎ Yes  ◻︎  No
if yes, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________

As a caregiver, you may be required to manually lift or transfer a patient. The average weight may be 70 lbs. Will you be able to do that? ◻︎ Yes  ◻︎  No
if no, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________

Do you have any employment restrictions resulting from a non-compete or confidentiality agreement?  ◻︎ Yes  ◻︎  No
if yes, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________

Are you willing and able to drive for our concierge clients using your or their car?  ◻︎ Yes  ◻︎  No
if yes, please provide insurance information: ____________________________________
________________________________________________________________________
________________________________________________________________________



Work Eligibility

 

Please know if you are offered a position with Loving Hands of Nevada the following proof of work eligibility must be presented:
 
Driver's license or government issued picture ID
US Social Security card
 
At Loving Hands of Nevada we believe transparency and honest communication provides the best work experience for all.  Taking care of people is a large responsibility for you and for us. Therefore we hope you understand why the following background checks are performed before you can start work: 

Original FBI Criminal Abstract
Original Driving Abstract
Adult Protective Services (APS) Central Registry Check
Child Welfare Services (CWS) Central Registry Check

Before starting to work with us you will also need the following (if you already have all or any of these items please bring them with you to your initial interview):
Current CPR card
Current First Aid card
Current TB clearance
Professional Certification PCA

Agreement: Please read the following statements carefully and indicate you have done so by clicking on the “Submit” button below:

 

"I certify the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release providers of reference information, as well as Loving Hands of Nevada from all liability for any damage that may result from utilization of such information."

 

 

 

Thank you for your interest in Loving Hands of Nevada