Job Application Form

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Name *

First

Last

Phone *

Email *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Position Applying For

Desired Employment Type

Full-Time
Part-Time
PRN/Flexible
Live-In

Available Start Date

Are you legally authorized to work in the U.S.? *

Do you have a valid driver’s license? *

Professional License/Certification (if applicable) to be uploaded as an attachment *

Click or drag a file to this area to upload.

Special Training or Skills ( to be uploded)

Click or drag a file to this area to upload.

Work Experience (upload the resume) or manually enter the information below

Click or drag a file to this area to upload.

Employer Name

Job Title

Employment Dates (From – To)

Responsibilities / Duties

Reason for Leaving

Education

Highest Level of Education Completed:

School Name

Major / Field of Study

Provide two professional references (not relatives):

Name *

Relationship *

Phone *

Email *

Have you ever been convicted of a misdemeanor or felony?

If yes, please explain: _______________________________ (does not automatically disqualify applicants)

Resume Upload

Click or drag a file to this area to upload.

Upload Résumé: (Accept .pdf, .doc, .docx files)

“I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false information may result in disqualification or termination if employed.” *

I agree to the above statement.

Are you authorized for employment in this country? (Proof of U.S. citizenship or immigration status will be required upon employment.) *

What are the last four digits of your social security number? *

What type of work are you looking for? *

Have you received the Flu Vaccination? Required for all Direct Care positions. *

I understand that a negative tuberculosis test must be submitted to Human Resources within 21 days from the employment start date for all direct care positions in order to work in the programs. *

Have you ever been employed by Tecwise LLC / Delight Senior Home Support Services.? *

Have you ever been dismissed or forced to resign or have you ever resigned in order to avoid being dismissed? *

In Virginia, or any other location, have you ever been or are you presently the subject of any complaint of abuse or neglect? *

Have you ever been convicted of or are you the subject of pending charges for a crime? *

Have you been driving 3 years or longer with a valid U.S. Driver's License? *

Driver's License Number 12) (Required for all Direct Care Positions). *

Note: Driving record is reviewed by Human Resources as part of the screening process.* insert the box for the DL number.

If an employment offer is made to me, I authorize Tecwise LLC / Delight Senior Support Services to communicate with all my former employers, school officials and persons named as references. I authorize all former employers and references to provide any information they may have regarding my performance and character. I hereby release all employers, schools and individuals from any liability for any damage whatsoever resulting from giving such information. *

I understand that if I am hired for a position, I will be required to have my fingerprints taken. I will also be asked to provide certain other information so that a comprehensive criminal background record check can be conducted. If my record contains any element that Tec-Wise LLC/ Delight Senior Support Services finds objectionable or if any information is not consistent with what I report in my employment application, and background check disclosure statement completed during the onboarding process, I understand I may be discharged immediately. I understand that any false information contained in this application may result in my discharge. *

Section 503 Disability Status If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Click Voluntary Self-Identification of Disability Form to learn more about voluntarily telling us if you have or have had a disability. Check Box: I have read the Voluntary Self-Identification or Disability Form and understand that I have the option to disclose whether or nor not I am an individual with disability. *

Yes, I Have a Disability, or Have a History/Record of Having a Disability
No, I Don’t Have a Disability, or a History/Record of Having a Disability
I Don’t Wish to Answer
I have read the Voluntary Self-Identification or Disability Form and understand that I have the option to disclose whether or nor not I am an individual with disability.

I certify that I have read and understand the applicant instructions included with this application and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I understand that this application form is intended for use in evaluating my qualifications for employment and that this application is not an offer of employment. I further understand that if hired, my employment will be considered "at-will" and that my employment may be terminated for any reason, with or without cause or notice, at any time by me or Tec-Wise LLC/ Delight Senior Support Services and that this application is not intended to constitute a contract of continued employment. *

Yes, I agree to sign electronically.

Job Application Form

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