Careers – My Love and Care

Personal

Availability

Background

Education

Employment

References

Submit

Personal Information

All fields marked with * are required.

Position Applied For *

Date of Application

Full Name *

Social Security # *

Date of Birth *

Phone # *

Email *

Physical Address

Street Address *

City *

Zip Code *

Mailing address same as physical address

Background Information

Please answer honestly. Responses will not automatically disqualify you.

Previously worked at Love 'N Care? *

Yes No

When and reason

Convicted of a crime in the past 7 years? *

Yes No

Explain (dates and charges)

Conviction will not necessarily disqualify you.

Languages Spoken *

Spanish only English only Both

Emergency Contact

Name *

Relationship *

Phone *

Educational Background

Fill in what applies. Leave blank if not applicable.

School Type	Name / City	Course or Major
High School
College
Postgraduate
Business/Trade
Other

Employment History

List your last 3 employers, starting with the most recent.

Employer 1 (Most Recent)

Employer *

Phone

Address

From

Job Title

Supervisor

Starting Salary

Final Salary

Duties & Responsibilities

Reason for Leaving

Contact for Reference?

Employer 2 (Optional)

Employer

Phone

Address

From

Job Title

Supervisor

Starting Salary

Final Salary

Duties & Responsibilities

Reason for Leaving

Contact for Reference?

Employer 3 (Optional)

Employer

Phone

Address

From

Job Title

Supervisor

Starting Salary

Final Salary

Duties & Responsibilities

Reason for Leaving

Contact for Reference?

Skills, Qualifications & Comments

References (3 Required)

You must provide 3 references (not immediate family) who know your work ethic and abilities. All 3 are required.

Name *

Phone *

Years *

Relation *

Name *

Phone *

Years *

Relation *

Name *

Phone *

Years *

Relation *

Certification & Signature

Please read and agree to the following.

I certify that the facts in this application are true and complete. Misrepresentation will be cause for rejection or dismissal.

I understand my employment is not guaranteed for any term and may be terminated at any time by either party.

If employed, I agree to comply with Love 'N Care's safety, health rules, and code of conduct.

This application remains active for one year. I authorize investigation of all statements made herein.

If required, I agree to drug testing. Love 'N Care is an Equal Opportunity Employer.

Type Full Name as Signature *

Date

I have read and agree to the terms above *

✅

Application Submitted!

Thank you! Love 'N Care will review and contact you shortly.

Language

Join Our Care Team

Why work at Love 'N Care

Competitive pay

Flexible schedules

Paid training

Supportive team

Career growth

Make real impact

Open Positions

Personal Care Attendant

Pediatric Caregiver

Care Coordinator

Employer 1 (Most Recent)

Employer 2 (Optional)

Employer 3 (Optional)

Application Submitted!

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