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Gardens Application
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Name
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First
Last
[object Object]
Have you worked under another name? If so, what was it?
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Phone Number
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Email
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Date of Birth
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Social Security Number
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We take your privacy very seriously and will NOT sell this or share this with anyone besides our payroll company and our background checking company.
Arizona Code R9-10-803.A.8 requires that you must be able to read, write, and communicate in English to work at our facility. Do you meet this requirement?
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Yes
No
The position you are applying is very physically demanding. You will need to be on your feet for 12 hours while also squatting, kneeling, bending, lifting, and transferring people who can't do it themselves. Are you able to perform these job requirements?
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Yes
No
Do you have a valid fingerprint card from the Department of Public Safety according to ARS 36-411.A?
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Yes
No
No, my card has expired.
Do you have a valid driver's license from the state of Arizona?
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Yes
No
No, I do not drive
No, my driver's license is from another state
How will you get to work?
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My car
Taxi or Uber
Bus
Walk
Are you an Arizona Certified Caregiver in all three levels who has passed the state test?
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Yes
No, but I have my direct care certificate
No, I have no formal training
No, but I am a CNA
No, but I have certificates from another state
What was the name of your Caregiver Training Program?
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What year did you receive your Supervisory, Personal, and Directed Caregiving Certificates?
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How many years or months of experience do you have as a caregiver? Please explain.
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Do you have current in-person training in CPR/First-Aid?
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Yes
No, I did it online
No
Do you have current documentation of freedom from tuberculosis?
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Yes
No
Are you vaccinated against Covid?
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Yes
No, but I'm willing to be
No
What shift are you looking to work
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Days (7 AM to 7 PM)
Nights ( 7 PM to 7 AM) *This is a working shift
Either Days or Nights
What days of the week can you NOT work? Please fill free to explain or not.
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Three Employment References (Required by Arizona under statute A.R.S 36-411)
1. Name of Company
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Supervisor's Full Name
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Company's Phone Number
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How long did you work there? From what month and year to what month and year?
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Company Address
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2. Name of Company
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Supervisor's Full Name
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Company's Phone Number
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How long did you work there? From what month and year to what month and year?
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Company Address
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3. Name of Company
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Supervisor's Full Name
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Company's Phone Number
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How long did you work there? From what month and year to what month and year?
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Company Address
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Three Personal References (Please tell the they will be called by us)
1. Full Name
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Phone Number
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How do you know this person?
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2. Full Name
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Phone Number
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How do you know this person?
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3. Full name
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Phone Number
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How do you know this person?
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Job Application Disclaimer & Acknowledgement
I hereby assert that the answers given on this application are true and complete to the best of my knowledge. I authorize The Gardens at San Carlos to make investigations and inquiries of my personal, employment, financial, and medical history and other related matters to arrive at an employment decision. I hereby release employers, schools, and persons from all liability in responding to inquiries connected to my application. In the event that I am hired, I understand that false or misleading information given in my application or interviews may result in my termination of employment. I also understand that I must abide by all rules and regulations of the company, and by all state and federal laws, rules, and regulations regarding the operation of assisted living homes.
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Yes
No
Electronic Signature agreeing to job application disclaimer & acknowledgement statement
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First
Last
How did you hear about our company?
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Optional Resume (Cut & Paste)
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Max file size: 20MB
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