Employment Application - Apply Online

You may submit your employment application online by using the form below. Important: The sections marked with * are required. You will get a chance to review your information and make corrections before submitting.

First Name *
Middle Name
Last Name *
Home Address: *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
How long have you lived at this address? *
Email address *
Home Phone * - (###) - ### ####
Cell Phone - (###) - ### ####
Desired Position
Select the position you are applying for *
Required Starting Rate *
Enter Days & Times You Are Available to Work *
Previous Employment History
Most Recent Employer

Please enter the name of your most recent employer.
Employer Name
Employer Phone - (###) - ### ####
From date / MM / DD YYYY
To date / MM / DD YYYY
Position Title
Starting Salary
Ending Salary
Reason for leaving
List duties
Previous Employer One
Employer Name
Employer Phone - (###) - ### ####
From Date / MM / DD YYYY
To Date / MM / DD YYYY
Position Title
Starting Salary
Ending Salary
Reason for leaving
List duties
Previous Employer Two
Employer Name
Employer Phone - (###) - ### ####
From Date / MM / DD YYYY
To Date / MM / DD YYYY
Position Title
Starting Salary
Ending Salary
Reason for leaving
List duties
Education: High School
Enter High School Name: *

Please enter the name of the high school you attended.
Did you graduate? * Yes No
Please select whether you graduated or not.
Education: College
Enter College Name:
Did you graduate? Yes No
Education: Other
List other Educational Institute:
Did you graduate? Yes No
If the answer to the above is yes, list degree earned:
Certifications
Are you a Certified Nurse Assistant listed on the NC Registry? * Yes No
Other:
Are you a U.S. citizen or lawfully authorized to work in the U. S.? * Yes No
Are you able to be in a home with a Cat? Yes No
Are you able to be in a home with a Dog? Yes No
Are you able to be in a home with someone who smokes? Yes No
Do you have a valid driver’s license? * Yes No
Do you have your own transportation? * Yes No
(This information will be reviewed for job relatedness and will not necessarily disqualify an applicant from employment.)
Have you ever been convicted of a misdemeanor? * Yes No
Have you ever been convicted of a felony? * Yes No
Additional Comments and Information:
Enter any additional information or comments here:
I certify that the facts contained herein are true and complete. I understand that falsified statements shall be considered cause for discharge.

I understand that any offer of employment made by Center Peace Home Health Care & Companion Services is contingent upon the satisfactory results of a criminal background check and additionally, in some instances, a motor vehicle report and drug test.

Employment Application - Apply Online

Desired Position

Previous Employment History

Most Recent Employer

Previous Employer One

Previous Employer Two

Education: High School

Education: College

Education: Other

Certifications

Other:

(This information will be reviewed for job relatedness and will not necessarily disqualify an applicant from employment.)

Additional Comments and Information:

Member - Association for Home & Hospice Care of North Carolina (AHHC) Member - Fuquay-Varina Area Chamber of Commerce

Member - Association for Home & Hospice Care of North Carolina (AHHC)
Member - Fuquay-Varina Area Chamber of Commerce