Employment Application - Apply Online

Please complete the form below to be considered for employment at CenterPeace.

Personal Information













Most Recent Employer







Previous Employer








Previous Employer








Education - High School

Did you graduate?



Education - College

Did you graduate?



If the answer to the above is YES, list degree earned.


Education - Other

Did you graduate?



If the answer to the above is yes, list degree earned.


Are you a Certified Nurse Assistant listed on the NC Registry?


Other

Have you ever been charged or convicted of a crime ?


Are you a U.S. citizen or lawfully authorized to work in the U. S.?


Are you able to be in a home with a Cat?


Are you able to be in a home with a Dog?



Are you able to be in a home with a Smoker?



Do you have a valid driver’s license?



Do you have your own transportation?



Additional Comments/Information:

I certify that the facts contained hererin are true and complete. I understand that falsified statements shall be considered cause for discharge.

I understand that any offer of employment made by CenterPeace Home HealthCare & 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.

*Note: If selected for an interview, additional forms and paperwork will be needed.

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

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