Home Team Kansas Online Employee Application - Return to HomeTeamKS.com Home Page

Check the position(s) you are applying for :
Homemaker/Home Care Aide Certified Nursing Assistants/Nursing Assistants
Housekeeper/Staffing Services Licensed Practical Nurse
Attendant Care Registered Nurse
Companion Other
if other, please fill in the position you are applying for:
Referral Source?: Internet Newspaper Employee Walk-in
Name of Source (if applicable):
Please enter the cities/towns that you are interested in working in.
  First Name Last Name Middle Initial
 
 
  Address 1 City  
 
  Address 2 State Zip Code
 
  Primary Telephone Number Secondary Telephone Number (cell)
  ( ) - ( ) -
 
Email Address
 
Are you eighteen years or older?
YES
NO
Required fields are in RED
Have you ever been employed with Home Team KS?
YES
NO
if yes, give date:
Are you a preferred caregiver?
YES
NO
If you are under eighteen, can you furnish a work permit?
YES
NO
Have you filed an application here before?
YES
NO
 
if yes, give date:
 

Are you legally eligible to be employed in this country? ............ ............... ................ (Proof of U.S. Citizenship or immigration status will be requested upon employment.)

YES
NO
Are you able to meet attendance requirements of the position? *
YES
NO
Will you work overtime if requested?
YES
NO
Have you ever been bonded?
YES
NO
Have you ever been convicted of a crime or felony?
YES
NO
If yes, please provide date(s) and please explain in the space provided:
* Most assignments are during normal business hours (Mon. - Fri. 8am - 5pm) ; however, some assignments require workers to be available during evening and/or weekend hours.

List your last four (4) employers, assignments or volunteer activities; starting with the most recent and including military experience. Explain any gaps in employment in the Comments section below.

1. Employer's Name:
  Street Address:
  City: State:
Zip Code:
  Phone: ( ) - -
  Job Title: Immediate Supervisor and Title:
  Reason for leaving:
Dates Employed: FROM:
TO:
  
Below Summarize the nature of the work performed and job responsibilities:
Hourly Rate: START: FINISH:  
Salary: START: FINISH:  
May we contact for reference? NO LATER

2. Employer's Name:
  Street Address:
  City: State:
Zip Code:
  Phone: ( ) - -
  Job Title: Immediate Supervisor and Title:
  Reason for leaving:
Dates Employed: FROM:
TO:
  
Below Summarize the nature of the work performed and job responsibilities:
Hourly Rate: START: FINISH:  
Salary: START: FINISH:  
May we contact for reference? NO LATER

3. Employer's Name:
  Street Address:
  City: State:
Zip Code:
  Phone: ( ) - -
  Job Title: Immediate Supervisor and Title:
  Reason for leaving:
Dates Employed: FROM:
TO:
  
Below Summarize the nature of the work performed and job responsibilities:
Hourly Rate: START: FINISH:  
Salary: START: FINISH:  
May we contact for reference? NO LATER

4. Employer's Name:
  Street Address:
  City: State:
Zip Code:
  Phone: ( ) - -
  Job Title: Immediate Supervisor and Title:
  Reason for leaving:
Dates Employed: FROM:
TO:
  
Below Summarize the nature of the work performed and job responsibilities:
Hourly Rate: START: FINISH:  
Salary: START: FINISH:  
May we contact for reference? NO LATER
 
COMMENTS: (including explanation of any gaps in employment)
SKILLS AND QUALIFICATIONS :
Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work at our company.
 
EDUCATIONAL BACKGROUND
NAME AND LOCATION YEARS COMPLETED DID YOU GRADUATE? COURSE OF STUDY

High School:

College: Major:

Degree:
Other:

REFERENCES *(Do not list relatives/family members )
NAME
TELEPHONE
 YEARS KNOWN
1.
2.
3.
If you do not complete this application in its entirety we will not be able to process it. So recheck your work before clicking the "Submit Application" button.
Please read the following information below.

Check this box and type in your FULL name (FIRST AND LAST) if you fully understand and agree to the terms above.
TYPE IN YOUR FULL NAME:
IMPORTANT: You must agree to the terms above and type in your full name in order for us to process your application.

*Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law.

*Home Team Kansas is an equal opportunity employer.

 

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