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Learn more about the advantages of having a home care professional to support your loved one and assist your family. Contact us via phone or email for more details about our services. You may also fill out the form on this page to send a message. We will get back to you as soon as possible.

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CHAA, CNA, LPN, RN

Join Our Team

For interested applicants, download the PDF file below, fill out all the important information, and sent it to kindercare@kinderhealthcareservices.com.

Application Form

APPLICATION FOR EMPLOYMENT

PERSONAL DATA:*

Date Of Birth*

CELL PHONE #*

Email Address*

PRESENT ADDRESS *

POSITION DESIRED:*

SS#:*

TYPE OF LICENSE: R.N, L.P.N, H.H.A, OR N.A (Pls circle one)*

License Issuing Authority or board:*

License #*

License expiration date: *

Malpractice Insurance?*

Malpractice Insurance Policy #*

Male/ Female*

Open to Live-In Care – Yes / No*

Vehicle (Year, Make)*

Driver’s License – Yes / No*

PLACEMENT INFORMATION:*

Ideal Number of Hours Per Week*

HOURS AVAILABLE TO WORK:*

MONDAY*

TUESDAY*

WEDNESDAY *

THURSDAY*

FRIDAY*

SATURDAY*

EDUCATION: LIST BUSINESS SCHOOLS, COLLEGES ATTENDED AND ANY RELATED CLASSES*

NAME OF SCHOOL / LOCATION / SUBJECT / DEGREE / YEARS*

REFERENCES 1:*

REFERENCES 2:*

Personal Ref 1:*

Personal Ref 2:*

EMPLOYMENT HISTORY:*

SUPERVISOR’S NAME: May We Contact? Yes or No?*

ADDRESS OF PRESENT/LAST EMPLOYER*

POSITION TITLE:

CURRENT OR END SALARY / WAGE*

SUMMARY OF DUTIES*

DATES EMPLOYED*

REASON FOR LEAVING *

NEXT PREVIOUS EMPLOYER*

TELEPHONE NUMBER:*

SUPERVISOR’S NAME: May We Contact? Yes or No?*

ADDRESS*

POSITION TITLE*

CURRENT OR END SALARY / WAGE*

SUMMARY OF DUTIES*

DATES EMPLOYED*

REASON FOR LEAVING *

EXPERIENCE WITH SENIORS AND SPECIAL NEEDS POPULATIONS*

HAVE YOU HAD A TB TEST IN THE PAST 3 YEARS?*

TESTED POSITIVE / NEGATIVE *

HAVE YOU BEEN CONVICTED OF A CRIME? *

IF YES, PLEASE EXPLAIN THE CRIME AND DATE CONVICTED?

DO YOU HAVE A CLEAN DRIVING RECORD?*

IF NO, PLEASE EXPLAIN?

By signing this application, I certify this information to be true and agree to allow Kinder Healthcare Services to perform a criminal history background check, DMV records at their leisure, and I, _______________________ hereby authorize Kinder Healthcare Services to request and receive from all prior employers within one year of the date of this application, and all the pertinent information concerning my prior employment and its termination, including the reason for such termination.*

Please copy the agreement form below paste it on the body of your email along with your Name, Signature and Date and send to to: kindercare@kinderhealthcareservices.com

Signature: ___________________

Date: ______________________

Contact Information

Kinder Healthcare Services LLC

830 Morris Turnpike 4th Floor

Short Hills, New Jersey 07078

Phone: 908-884-0412 | Email: kindercare@kinderhealthcareservices.com

Service Area

All Over New Jersey

Office Hours

Monday to Friday: 9:00 AM – 6:00 PM

*Please note that our services are available 24/7. Our emergency lines are also open round-the-clock.

Kinder Healthcare Services LLC