Pre-Screening

Employment Form

Compassionate Care At Home

Pre-Screening Employment Form

We at Compassionate Care at Home believe that registering the best caregivers leads to greater client satisfaction. If you are a compassionate, hardworking, and dedicated individual seeking work as a caregiver in Connecticut, call us today at 203-433-4325 or fill out the form below.

If you are interested in a position with Compassionate Care at Home, fill out the form below and we will contact you as soon as possible.

* Indicates Required Fields

Name *

Address*

Phone*

City*

Email Address *

State*

Are you interested in*

CNA?*
Yes    No

Do you have a car?*
Yes    No

What days are you available to work? (Check all that apply)*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

When are you available to work? (Check all that apply)*
Mornings (6am - 12pm)
Afternoons (12pm - 4pm)
Evenings (4pm - 10pm)
Overnights (10pm - 6am)
Live In (24 hours)

How did you hear about us?

Special Skills

  I authorize and agree to statement below.*

Why do you want to work with Compassionate Care?


I HEREBY AUTHORIZE Compassionate Care at Home TO REQUEST AND RECEIVE FROM ALL PRIOR EMPLOYERS WITHIN ONE YEAR OF THE DATE OF THIS APPLICATION ANY AND ALL PERTINENT INFORMATION CONCERNING MY PRIOR EMPLOYMENT AND ITS TERMINATION, INCLUDING THE REASONS FOR SUCH TERMINATIONS. I hereby state that the information I have provided is a true and complete statement of the facts. False statements contained in this application are immediate cause for dismissal from registrant caregiver status. I further give permission for Compassionate Care at Home to verify all information provided.**

Mission Statement

Our mission is to make a difference in the lives of seniors who wish to retain their independence in the comfort of their home. We strive to bring peace of mind to our seniors, as well as their families. We are committed to providing affordable, trustworthy, and personalized care.

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