Employment Application - Apply Online

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

Personal Information First Name :
Middle Name :
Last Name :
Address :
City :
State :
Zip Code :
How long have you lived at this address? :
Phone :
Date Of Birth :
Email :
Position You Are Applying For :
Required Starting Rate :
Available to Work (Days & Times) :

Most Recent Employer Company Name :
Company Phone :
From (month/year) :
To (month/year) :
Position Title :
Starting Salary :
Ending Salary :
Reason For Leaving :
List Duties :

Previous Employer Company Name :
Company Phone :
From (month/year) :
To (month/year) :
Position Title :
Starting Salary :
Ending Salary :
Reason For Leaving :
List Duties :

Previous Employer Company Name :
Company Phone :
From (month/year) :
To (month/year) :
Job Title :
Starting Salary :
Ending Salary :
Reason For Leaving :
List Duties :

Education - High School Enter High School Name:

Did you graduate?

Yes :
No :

Education - College
College :

Did you graduate?

Yes :
No :

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

Degree :

Education - Other
List Other Educational Institue :

Did you graduate?

Yes :
No :

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

Degree :

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

Yes :
No :

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.

Employment Application - Apply Online

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