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(336)265-7780 / (434)799-5731

Careers

At Care At Your Site, we’re dedicated to providing exceptional in-home care to those in need, and we’re looking for passionate individuals to join our team. As a part of our team, you’ll have the opportunity to make a meaningful difference in the lives of our clients, offering personalized care and support in the comfort of their homes.

Employment Form

Step 1 of 8

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Section 1. Your Personal Information

Your Name

First Last

Your Phone

Your Email Address

Driver's License Number

Address

Street Address Address Line 2 City State ZIP Code

Section 2. General Information

Are you 18 years old or older?(Required)

Yes

No

Date Available(Required)

Job Type(Required)

Driver License Expiration Date

Auto Insurance Expiration Date

Can you provide documentation of a driver's license and auto insurance?(Required)

Yes

No

Have you ever been convicted of, or plead guilty or no contest to, a misdemeanor or felony in this state or any other?(Required)

Yes

No

If yes, please explain(Required)

Section 3. Education

Name of High School:(Required)

Location of High School:(Required)

Did you graduate?(Required)

Yes

No

Years Attended (From/To)(Required)

Additional Education (vocational, undergraduate, etc.)(Required)

Yes

No

If yes, please list the name of the school and years attended (From/To)(Required)

Section 4 - Other Training: Certifications/Licenses

Certifications/Licenses

Section 5 - Current Employment

Current Employer

Address

Street Address Address Line 2 City State ZIP Code

Start Date

End Date

Position/Title

Hours Worked

Describe Your Responsibilities

Supervisor's Name/Title

Supervisor's Phone

Reason for Leaving

May we contact?

Yes

No

Section 6 - Employment History

Last Employer

Address

Street Address Address Line 2 City State ZIP Code

Start Date

End Date

Position/Title

Hours Worked

Describe Your Responsibilities

Supervisor's Name/Title

Phone

Reason for Leaving

May we contact?

Yes

No

Section 7 - Reference 1

Name(Required)

First Last

Company(Required)

Phone(Required)

Section 8 - Reference 2

Name(Required)

First Last

Company(Required)

Phone(Required)

Section 9 - Emergency Contact Information

Name(Required)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone 1(Required)

Phone 2

Relationship(Required)

Almost there

Upload Your Resume

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Signature(Required)

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

At Care At Your Site, we’re committed to redefining healthcare accessibility.

Bringing the personal care to you.

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Home
Resources
Careers
Events
About Us
Contact Us

Contact Us

(336) 265-7780
(434) 799-5731
(336) 355-9092
(434) 799-5730
[email protected]
2216 W Meadowview Rd Ste 254 Greensboro,
NC 27407
126 Woodside Dr STE F Danville, VA 24540

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