Caregiver Pre Hire

Thank you for your interest in joining the Heartfelt Care at Home Team!

We are looking forward to meeting you at your scheduled in person interview.

You will be emailed a reminder of your interview time and location.

Please be sure to bring with you:

  • Driver’s License
  • Social Security Card (un-laminated)
  • Proof of Current Care Insurance
  • Vehicle Registration
  • Any licenses or certifications that you might hold (C.N.A., etc.)

*Please be prepared for an on-site drug screen.  (any testing includes screening for THC)*

Before arriving at your scheduled interview, please make sure that you have reviewed the following documents and submitted your acc:


Your duties as a caregiver may include non-medical tasks such as: companionship, safety oversight and supervisory care, medication reminders, transportation, meal preparation, laundry, light housekeeping and other household duties as requested.

Your duties as a caregiver may include personal care tasks such as assistance with: bathing, dressing, toileting, transferring, and incontinence care.

By checking and submitting below, you acknowledge and agree to the following:

I certify that the information contained in my application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or, if hired, dismissal.

I authorize any insurance company, employer, educational institution, law enforcement organization, state or federal government agency, information service bureau, medical facility or practitioner, and any other person or organizations listed in this application to release information regarding my character, performance, qualifications, background, reasons for termination of past employment, and eligibility for rehire to Heartfelt Care at Home.  I also understand that as a condition of my employment I will complete a background check including, but not limited to, criminal records, social security number verification, and driving record.  I also authorize the release of my driving history and criminal records, and understand that it may contain information about my background, mode of living, character, and personal reputation.  I understand that a criminal conviction is not an automatic bar from employment and will be reviewed for job related impact.  I authorize you to request and receive such information, and release you and all parties involved in providing such information from any responsibility or liability.  I understand that the decision to hire is solely that of Heartfelt Care at Home. I fully accept the conditions of the background check listed on the Background Check Disclosure link listed above throuh Intellicorp.

As a condition of my employment with the Company, I agree that all information which I receive in the course of my employment relating in any manner to, among other things, the business activities, customers, production processes, financial affairs, programs, concepts or designs of Heartfelt Care at Home are to be treated by me as trade secrets and kept in confidence, not to be disclosed to any unauthorized person either during or after my employment, or used by me in any manner adverse to the interests of Heartfelt Care at Home.  In addition, I may be required to sign a separate Invention and Confidentiality Agreement.

In consideration for my employment by your Company, I agree to conform to the rules and regulations of the Company and acknowledge that these rules and regulations may be changed, interpreted, suspended, withdrawn, or added to by your Company at any time, at the Company’s sole option and without any prior notice to me.

I further acknowledge that my employment is at-will and may be terminated, and any offer of employment, if such is made, or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of the Company or myself.   I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Heartfelt Care at Home and myself for either employment or for providing of any benefit.

If my services terminate after accepting employment, I understand that Heartfelt Care at Home, or any of its affiliates may supply, in confidence, my employment record to any prospective employer, with no liability to the Company or its staff.

I acknowledge that I have been advised that my application will remain active for no more than sixty (60) days from the date it was made.

Additionally, you acknowledge receipt of, and understand and agree to the following company policies/forms/rules/etc.

  • Job Descriptions
  • Cancellation Policy
  • On-Call Agreements
  • Employee Handbook
  • Associate Acknowledgement
  • Quality Assurance
  • Training Video Requirements
  • New Hire Orientation
  • Policies and Procedures

Your Full Name (required)

Your Email (required)

Today's Date