Caregiver Application | WellSky Personal Care

Right at Home provides in-home care services to clients and equal employment opportunities to employees and applicants, without regard to race, color, religion, sex, national origin, age, disability, or other protected class, in compliance with all applicable federal, state and local laws. Each Right at Home office and business is independently owned and operated under a franchise agreement with Right at Home, Inc. For comments, questions or to learn more about Right at Home, please visit www.rightathome.net Please Read Carefully I certify that the information contained in this application is true, accurate, complete and correct. I understand and agree that any misrepresentation, falsification, or material omission of information on this application or any resume I submit may be grounds for the Company to refuse to employ me or terminate my at-will employment if I am hired. I further understand that the decision to hire is solely that of the Company. I understand and acknowledge that I am applying for a position with the Right at Home franchise identified on this web page (hereinafter the “Company”), which Company is independently owned and operated pursuant to a franchise agreement with Right at Home Inc., and that I am not applying for a position with the Company and not Right at Home, Inc. and if I am hired by the Company I will not be an employee of the Company and not Right at Home, Inc. I acknowledge that due to the nature of the Company’s business, attendance and punctuality are essential requirements of every job and that poor attendance or tardiness will result in disciplinary action or termination. I authorize the investigation of all the information I provided in this application, unless I have indicated otherwise. To the maximum extent allowed by law, I authorize any insurance company, employer, educational institution, law enforcement organization, governmental agency, information service bureau, medical facility or practitioner, and/or any other person or entity listed in this application to release information regarding me and my character, including but not limited to my performance, qualifications, disciplinary information, background, reasons for termination of past employment or volunteer service, and eligibility for rehire, to the Company and its affiliated entities, parent companies, franchisors, other franchisees, representatives, employees and clients. Also, to the maximum extent allowed by law, I waive written notice to me that employment information is provided by any person or entity. I also understand that as a condition of my application and at-will employment I will complete a background check including, but not limited to, criminal record check, social security number verification, and driving record, as allowed by law. I also authorize the release of my background check information, social security number verification, driving history and criminal records, and understand that they may contain information about my background, mode of living, character, and personal reputation, as allowed by law. I authorize the disclosure of all information about me, including but not limited to information obtained from the parties, entities and references I listed in this document, as well as information obtained by, through or from any background, employment, social security verification, driving record, and or criminal history checks, to the Company and its affiliated entities, parent companies, franchisors, other franchisees, representatives, employees and clients. I release the Company and its owners, agents, employees, officers, directors, attorneys, representatives, clients, insurers, parent companies, franchisors, other franchisees, and affiliated entities and persons from any and all liability as a result of soliciting, providing or receiving information regarding me or my character, or the use or disclosure of such information. The Company does not unlawfully discriminate in referrals, placements, or employment, and no question on this application is used for the purpose of limiting or excluding any applicant for consideration for referral, placement or employment on any basis prohibited by applicable laws or regulations. I understand and agree that the information supplied on this application has been given for the purpose of evaluating my qualifications for employment with the Company. However, I understand and agree that the Company does not guarantee my referral, placement, employment or terms of employment. I acknowledge that any offer of employment to me by the Company is contingent upon my timely completing INS Form I-9 and producing the proper documents required by the Immigration Reform and Control Act of 1986. My failure to meet these requirements within the specified time will result in the termination of employment. I acknowledge that I have been advised that this application will remain active for no more than sixty (60) days from the date it was made. (Please type your initials and date in the box below indicating that you have read and understand the statement above.

Active	Type	Expiration Date	Notes
	90 Day Evaluation
	Annual In-Service Training
	Car Insurance
	Car Registration
	Chest X-Ray
	Child Abuse Clearance
	CNA License
	Competency Exam
	Continuing Education RAH University
	CoVid Vaccine
	CPR Certification
	Direct Care Staff Training
	Driver's License
	First Aid Certification
	HHA Certification
	Identago <2yrs PA Resident
	LVN/LPN Certification
	MD background Clearance
	Medical Assistant
	Motor Vehicle History
	Orientation
	PATCH >2yrs PA Resident
	Performance Evaluation
	Registered Nurse
	Skills Checklist
	State ID Card
	TB Questionnaire
	TB Risk Assessment
	Tuberculosis Test
	USA Permanent Resident Card

Thank you for your interest in working for our agency.

Please submit the application below to be considered for a position as a caregiver.

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