Application Form

Caregiver Application-Confidential

Please complete the following information and submit to us in order to be considered for a home caregiver position with a client of Angel Touch Home Care. This information will remain confidential and nothing will be divulged which is not authorized by you. Day position will be 12.00 per hour. Live-in position will start at $110.00 per day.

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Transportation

Some Care giving position require either a car or valid drivers license, including current and valid insurance coverage

Employment History

Current and Previous Landlords

Personal References

Certification and release: I certify the above information stated and indicated are true in fact

and no misrepresentation of myself has been made. I understand that any false information,

omissions or misrepresentation of facts will result in rejection of this application and/or

discharge at any time during employment. I authorize Angel Touch to verify any all information

contained within this application, but not limited to, criminal history and motor vehicle driving

records. I authorize all persons, school, companies, and law enforcement authorities to release

any information concerning my background and hereby release any said persons, schools,

companies and law enforcement authorities from any liability for any damage whatsoever for

issuing this information. I also understand that the use of illegal drugs is prohibited during

employment and that I am willing to submit to drug testing at any time to detect the use of

illegal drugs prior to or during employment.

 

Restrictive Covenant: I agree not to do business directly with any individual or business entity

that Angel Touch has introduced to me or by entering into employment with such individuals or

business without our written permission

 

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