Thank you for your interest in working for Maximum Care Group. Please submit the application below to be considered for a position as a caregiver with Maximum Care Group/Lehigh Valley Visiting Nurses.


Qualifications Include:

  • At least 2-years of prior caregiving experience, equivalent nurses aid, or medical assistant training.
  • Minimum age of 21 years old
  • Proof of work eligibility
  • Must have valid driver’s license, vehicle registration & auto insurance
  • Clean criminal background, child abuse record & driving record
  • Ability to transfer patient, with assistive devices.

PLEASE PROVIDE - Personal Information:

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Mobile Phone:

Email:



PLEASE PROVIDE - Criteria of work experience. Please select checkboxes that match your skills & preferences:

General

Dementia Experience

Hospice Experience

Incontinence Experience



PLEASE PROVIDE - Experience with transfers:

Gait Belt Experience? YES or NO:

Hoyer Lift Experience? YES or NO:

Max client weight for transfers:



PLEASE PROVIDE - Days & hours that you are applying for, by selecting check box or filling in the lines below:

What days are you available for work?

What areas/towns would you prefer to work in? (i.e., Easton, Allentown, Bethlehem):

How many miles from your home are you willing to travel for work?:

Specify: a.m. p.m.

Hourly Work

Day Shift

Night Shift

Live-In Shifts? YES or NO:

OK with smoking clients? YES or NO:

How do you feel about pets?:

OK with cats? YES or NO:

OK with dogs? YES or NO:



PLEASE PROVIDE - Education & training:

High School:

College:

School/Other:

Degree received:



PLEASE PROVIDE - The following information & please answer ALL questions honestly:

Are you legally authorized to work in the United States? YES or NO:

Employment is subject to verification of U.S. citizenship or authorized alien status in accordance with the Immigration Reform and Control Act of 1986, after a conditional offer of employment is made.

Passport? YES or NO:

Driver's license? YES or NO:

Driver's License Number:

Do you have reliable transportation? YES or NO:

Insured Automobile? YES or NO:

Car Insurance Policy number:

Chest X-Ray? YES or NO:

Tuberculosis Test? YES or NO:


Have you ever been convicted of a misdemeanor within the past five years, other than a 1st conviction for drunkenness, simple assault, minor traffic violations, affray & disturbance of the peace? YES or NO:

If yes, Please explain:


Have you ever been convicted of a felony? YES or NO:

If yes, Please explain:

Have you ever been terminated or asked to resign from any job? YES or NO:

If yes, Please explain:



PLEASE PROVIDE - Certifications:

CPR Certification? YES or NO:

Registered Nurse? YES or NO:

LVN/LPN Certification? YES or NO:

CNA License? (enter YES or NO):

HHA Certification? YES or NO:

First Aid Certification? YES or NO:



PLEASE PROVIDE - Employment history:


Employer 1:

Start Date:

To - End date:

Supervisor:

Phone number:

Address:

City:

State:

Zip:



Employer 2:

Start Date:

To - End date:

Supervisor:

Phone number:

Address:

City:

State:

Zip:



Employer 3:

Start Date:

To - End date:

Supervisor:

Phone number:

Address:

City:

State:

Zip:



PLEASE PROVIDE - Professional references:



Reference 1 - Name:

Reference 1 - Phone Number:


Reference 2 - Name:


Reference 2 - Phone Number:


Reference 3 - Name:

Reference 3 - Phone Number:



PLEASE PROVIDE - Emergency contact information:

Name:

Phone Number:


DISCLOSURE

Maxcare is an equal-opportunity employer and is committed to providing a workplace free from harassment or discrimination. All employment decisions are made without regard to race, color, religion, gender, national origin, ancestry, sex, age, handicap, marital status, sexual orientation, physical or mental disability, pregnancy, military status, or any other basis prohibited by law.


Have you read the disclosure statement? (enter Yes or No):


Type full name here to complete application:


Please enter today's date:



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