Helping you care for a loved one by providing companionship, homemaking. Personal care and transportation services

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Providing Hourly, 8 & 12 Hour Shifts 24 Hour Live-In | Transportation Services
Offices in Norwalk, Waterbury, Trumbull, Hamden & Hartford

Job Application

Please fill out the following form to apply for a position with Connecticut In-Home Assistance.

Positions Interested In:

Do you have a car available for daily use?
Do you have a vehicle that can transport items to the dump?
Do you hold a current drivers license?
Would you be willing to use your car for client errands?
Would you be willing to use your car for client transportation?
Do you have any physical impairments that would interfere with your ability to perform the activities required of your position?
Have you ever been convicted of a crime of have criminal charges pending, excluding misdemeanors?
PLEASE NOTE:

Work schedule is based on client needs. Full-time work is not guaranteed. Most work schedules begin as part-time.
Please fill in the hours you are available to work each day:

Are you interested in 12 or 24 hour shifts?

Do you have any allergies to pets, cigarette smoke, other?
EDUCATION:

What is the highest grade completed?

Additional Training (check all that apply):

EMPLOYMENT RECORD (LAST 5 YEARS, BEGIN WITH CURRENT POSITION):
PERSONAL REFERENCES:

COPY AND PASTE YOUR RESUME OR TELL US ABOUT YOURSELF:

The information I have provided is true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in this application or interview may result in discharge whenever discovered. I understand, also, that I am required to abide by all rules and regulations of Connecticut In-Home Assistance, LLC.

I understand that all employment with Connecticut In-Home Assistance, LLC is on an at-will basis. Employees are free to resign or may be terminated at any time. Neither this application nor any other personnel forms or policies constitute and employment contract. I understand that no representative of Connecticut In-Home Assistance, LLC other then the owner(s) has any authority to enter into any agreement contrary to the foregoing and any such agreement must be in writing.

Connecticut In-Home Assistance, LLC does not discriminate on the basis of race, color, national origin, handicap, or age in admission or access to, service or employment in its programs or activities.