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Commonwealth House Assisted Living-01.jpeg

Commonwealth House Assisted Living

Job Application

Thank you for your interest in joining the Commonwealth House family! Our seniors deserve the best possible care, and that starts with our amazing caregivers...like you! Please answer ALL of the following questions as accurately as possible and we will follow up. ***Please note that you must be 18 years of age to be considered for a role as a caregiver and have at least 3 months of related experience.*** Other roles may have additional prerequisites.

First lets collect some basic information about you...

First name

Last name

Birthday

Social Security Number*

Address

Phone*

Email*

What position are you applying for?

When can you be available to start?

Are you a US Citizen or an alien authorized to work in the US?*

Yes

No

Have you been convicted of a felony in the past 5 years?

Yes

No

If the answer to the above question is yes, please provide an explanation here:

What is the date of your last Tuberculosis test or chest X-Ray?*

Here you can tell us a little about your educational history...

Where did you go to High School?

Did you graduate or receive your GED?

Yes

No

Date of Graduation

Tell us about college or other additional education experience you would like to share

Please write all of your qualifications that are applicable to this role here:

Please write your certifications here and when they expire/renew:

Please describe any special skills you can bring to the role:

Now help us learn about your previous experience. Please list your last 2 employers here, including your current employer. There will be a field to list further employment information at the end.

Employer #1

Name of Employer

Phone Number

Address

Supervisor's Name

Your Job Title

Salary

Responsibilities

Date of Hire

Date of End of Employment

Why did you leave?

May we contact your supervisor?

Yes

No

Employer #2

Name of Employer

Phone Number

Address

Supervisor's Name

Your Job Title

Salary

Responsibilities

Date of Hire

Date of End of Employment

Why did you leave?

May we contact your supervisor?

Yes

No

Please tell is about any additional employment you have had in the past 5 years

Please list 2-3 references including contact information.

By checking this box, you hereby certify that the above information is true and accurate. You also acknowledge that providing false or misleading employment information is grounds for immediate termination.

Commonwealth House Assisted Living-01.jpeg

655 Commonwealth Ave

Warwick, RI 02886

401-298-6986

Established in 2016

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