Franchise 315 Application Form

Application Form

We appreciate your interest in Comfort Keepers! We are an equal opportunity employer, dedicated to a policy of non-discrimination against any applicant or employee based on race, color, sex, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Comfort Keepers also prohibits harassment of applicants or employees based on any of these protected categories. It is also Comfort Keepers' policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.

Personal Information

First Name *

Last Name *

Home Phone *

Work Phone

Mobile Phone

Email *

Address 1 *

Address 2

City *

State

Zip *

Section 1 - Certified Nursing Aide

Referral Source (required)

Referral Source

I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered. I hereby authorize, to the extent allowed by applicable federal state and local laws, Comfort Keepers to conduct its own investigation of my references, employment history and education and, further, authorize the references and prior employers I have listed to disclose to the Company information related to my employment history and qualifications for the position for which I am applying, without giving me prior notice of such disclosure.

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