Business Line:
(877) 507-0779
On-Call Weekend Line:
(203) 507-0070
discoveringkindness@gmail.com
30 Hazel Terrace Suite #14 Woodbridge, Ct 06525
HCA.0001488
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Home
About
Services
Personal Care
Companion Care
Live-In Care
Homemaker Services
Memory Care
Developmental Disability Care
Mental Health Assistance
Blog
Service Areas
Careers
Employees
Trainings
Training for PCA
Training for PCA – Spanish Version
Resources
Client Orientation Packet
Incident Report
RA Monthly Note
10/30/60/90 Day Report
Client Home Visit
New Hire
New Hire Forms
Employee Orientation
Contact
APPLY NOW
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Date
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Full Name
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First Name
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Address
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Home Phone
Email
*
Cell Phone
*
Date of Birth
*
MM slash DD slash YYYY
Social Security Number
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Your Immigration Status
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Work Visa
Are you eligible to work in the United States?
*
Yes
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Gender
*
Male
Female
Open to Live-In Care
*
Yes
No
Convicted of a felony?
*
Yes
No
Vehicle Information
Vehicle Year
Vehicle Make
Driver's License
*
Yes
No
Experience
Untitled
Alzheimer's
Bed Bath
Cancer
Combative
Dementia
Dementia Experience
Gait Belt Experience
Glucose Monitor
Hospice
Hospice Experience
Hoyer Lift Experience
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Stroke
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Result
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How did you hear about us?
Emergency Contact Name
Emergency Contact Phone
Work Preference
Date Available
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Ideal Number of Hours Per Week
Shift Availability
Monday
Morning
Afternoon
Evening
Live-In
Tuesday
Morning
Afternoon
Evening
Live-In
Wednesday
Morning
Afternoon
Evening
Live-In
Thursday
Morning
Afternoon
Evening
Live-In
Friday
Morning
Afternoon
Evening
Live-In
Saturday
Morning
Afternoon
Evening
Live-In
Sunday
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Afternoon
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Live-In
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Subject Studied
Years Attended
Location
Degree
School Name
Subject Studied
Years Attended
Location
Degree
Reference
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Name
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Second Reference
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Years Known
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Address
Position Title
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To Date
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Summary of Duties
Reason for Leaving
Previous Employer
Employer Name
Telephone
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Position Title
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Summary of Duties
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