Account Associate Specializing In Home Care

Date of birth: *

Phone Number *

Address *

City, State, Zip *

Date of Application *

How did you hear about this position *

Are you available for overtime if needed? *

yes

no

What day are you available to start work, if hired? *

Have you ever applied to or worked for 24/7 Coastal Contact before? *

yes

no

If yes, when?

Are you 18 years of age or older? *

yes

no

Are you a US citizen or approved to work in the US? *

yes

no

What documents can you provide as proof of citizenship or legal status? *

Have you ever been convicted of a criminal offense (Felony or Misdemeanor)? *

yes

no

If so, Please state the nature of the crime(s), when & where this happened?

Job skills & qualifications- Please list all skills you possess for the position which you are applying:

High School- Name, Location, Year, Degree earned

College/University - Name, Location, year, Degree earned

Vocational school/ Specialized training - Name, Location, Year, Degree earned

Are you now or have you ever been a member of the armed services? *

yes

no

If yes, What branch of the military did you enlist?

What was your military rank when discharged?

How many years have you served in the military?

What military skills do you possess that would be an asset for this position?

Previous Employer 1: Name, Address, Phone, Supervisor name, Dates employed, Reason for leaving *

Previous Employer 2: Name, Address, Phone, Supervisor name, Dates employed, Reason for leaving *

Previous Employer 3: Name, Address, Phone, Supervisor name, Dates employed, Reason for leaving

Reference 1- Name, Number, Relation to you *

Reference 2- Name, Number, Relation to you *

Reference 3- Name, Number, Relation to you

Do you have good internet that does not buffer a lot that is at least 100 Mbps for download? If unsure you can check it at speedtest.net. *

Do you have access to a printer? *

What type of computer do you have? Please specify if it is a chrome book. *

Do you have an external mouse to use? If not would you be willing to purchase one? *

Do you have noise CX headphones? If not would you be willing to purchase a pair? *

Do you have access to a wireless hot spot through your phone or an external device in case of power or internet outage? If yes please specify which one. *

Does your router have an ethernet port? If not would you be willing to get one from your internet provider? *

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Account Associate Specializing In Home Care

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