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562-929-8400
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Employment Applications

We are a job placement / referal agency. A-1 Domestic is always looking to hire experienced Caregivers, Companions, Aides, Assistants, CNA, CHHA, Home Attendants, Sitters, Au Pair, Babysitters, Homemakers, Mother’s Helper & Nannies for non-medical In Home Care and Child Care services.

We are an equal opportunity employer. Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and / or interview process should notify a our Human Resources Department.

Contact Information:
Name
Nick Name
Address
E-Mail
Home Phone
Cell
Work
May we contact you at work?
If yes, best time to reach
you at work:
Genearl Information:
If under 18, can you furnish
a work permit?
If no, please explain:
Have you submitted an
application previously?
If yes, give date(s):
Have you ever been
employed here before?
If yes, give date(s):
Are you legally eligible
to work in this country?
Date available to work:
Position desired:
 
Will you relocate if job
requires it?
Will you travel if job
requires it?
Driver's license number:
State:
Are you able to meet the
attendance requirements
of the position?
Will you work overtime
if required?
 Yes No
If no, please explain:
Have you ever been
bonded?
Have you been convicted of
a crime in the last 7 years?
If yes, please explain:
Conviction will not necessarily be a bar to employment. Each instance and explaination
will be considered in relation to the position for which you are applying.
Employment History:

Most Recent Employer
Employer
Telephone
Address
Supervisor and Title
May we call for reference?
Your Job Title
Summarize the type of
work performed and
job responsibilities

Dates Employed

Starting Rate / Salary

Final Rate / Salary

From

To
$

per
$

per

Comments

(including explanation of

any gaps in employment)

Other Employment
Employer
Telephone
Address
Supervisor and Title
May we call for reference?
Your Job Title
Summarize the type of
work performed and
job responsibilities

Dates Employed

Starting Rate / Salary

Final Rate / Salary

From

To
$

per
$

per
Comments
(including explanation of
any gaps in employment)
   
Skills and Qualifications:
Summarize any special
training,skills, licenses
and / or certificates that
may qualify you as being
able to perform job-
related finctions in the
position for which you
are applying.
Educational Background:

List the last three (3) schools attended, starting with most recent. List number of years
completed. Indicate degree or diploma earned, if any. List grade point average and class
rank. As well as major and minor (if applicable) field of study.

School

Years Completed

Degree / Diploma

GPA / Class Rank

Major

Minor

Reference:

List name and telephone number of three (3) business / work references who are not related
to you and are not previous supervisors. If not applicable, list three (3) school or personal
references who are not related to you.

Name of Reference

Telephone Number

Years Known

Additional Information:

List professional, trade, business, or civic associations and any offices held. Exclude
memberships which would reveal sex, race, religion, national origin, age, color, disability or
any other similarly protected status.

Organization

Offices Held

List special awards,
accomplishments,
publications, etc.

List any additional
information you would
like us to consider.

Reffral Method:
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Note: Policy requires all applicants also fill out an application in person at our corporate headquarters. The information above is an exact copy of what will be asked on our paper application. If you'd like, please print this page for easy reference when called for an interview.




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