Thank you for your interest in applying for a position as a live-in Home Health Aide with Home Care Solutions. To begin the process for employment you should complete the application thoroughly. We do not accept incomplete applications. Please make sure the contact phone numbers are correct for previous employers and references, including area codes.
You can mail or fax your completed application to Home Care Solutions. We will contact you to schedule an interview.

Download Employment Application --> PDF Form

Or fill in the form below and apply right now.

EMPLOYMENT APPLICATION

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References :

Please list 4 professional references (not relatives). Give name and current phone number and relationship to you.
[Example: teacher, co-worker, landlord, doctor, pastor, rabbi, manager/supervisor, business owner, roommate, etc.]

# Name Phone Number Relationship
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2
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4

List previous jobs starting with most recent. If you need more room attach another sheet or write on back. It is important to list duties and/or experiences related to home care, nursing or any specific therapy you are qualified for.

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EDUCATION :

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SPECIAL SKILLS :

Disclosure and Authorization for Background Investigation

I hereby authorize Home Care Solutions (hereinafter referred to as The Company), Global HR and the Minnesota Department of Human Services, as directed by The Company, to obtain a consumer report and / or an investigative consumer report for employment purposes. I understand this report may include inquiries regarding my educational background; work history; court records; including criminal as permitted by law; driving history; workers compensation history; immigration status; general reputation; performance; experience; and references obtained from professional and personal associates and other qualities pertinent to my qualifications, for employment, including reasons for termination of past employment. I further understand and agree that a consumer report may be obtained at any time, and any number of times, as The Company in its sole discretion determines is necessary before, during, or after my employment.

Medical and worker s compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA), and / or any other applicable state laws. The Fair Credit Reporting Act gives you specific rights. If we rely on the report for an adverse action, before taking the adverse action we will give you a pre-adverse action disclosure that includes a copy of the report.

By my signature below, I hereby authorize all previous employers, educational institutions, consumer reporting agencies, and other persons or entities having information about me to provide such information to The Company or other entity, including Global HR and the Minnesota Department of Human Services, that obtains information for the company. I further fully release The Company, its employees, officers, directors, agents, successors and assigns, and all other parties involved in this background investigation, including but not limited to Global HR and the Minnesota Department of Human Services, and its employees, officers, directors and agents, and including all consumer reporting agencies, and those companies or individuals who provide information to Global HR, the Minnesota Department of Human Services or The Company concerning me, from any claims or actions for any liability whatsoever related to the process or results of the background investigation.

My signature allows a photocopy or fax copy of this authorization to be as valid as the original.

I verify that the above information is correct at the time of speaking and will take full responsiblity for any incorrect information I may have provided.