Careers Form – Serenity Home Healthcare

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faxes@serenityhhc.com
6640 W. Touhy Ave. Niles, IL 60714
(773) 588-4000

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Serenity Home Services – Indiana

Serenity Career Application

Full Name*
First Name Last Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Date Available*
MM slash DD slash YYYY
Desired Salary
Position Applied For:*
How did you find out about Serenity?*
Are you authorized to work in the US?*
- Yes
- No
Have you ever worked for this company?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
Have you done a background check?*
- Yes
- No
Background check view section:
Full Name*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Other Names Used*
Telephone*
States Where You Have Lived*
Gender
- Male
- Female
Race
Race
- A Chinese, Japanese, Filipino, Korean, Polynesian, Indian, Indonesian, Asian Indian, Samoan, or any other Pacific Islander.
- B Balck or African American(Not Hispanic or Latino)
- hHispanic or Latino(Mexican, Puerto Rican, Cuban Central or South American, or other Spanish culture or origin)
- IAmerican Indian, Eskimo, or Alaskan native, or person having origin in any of the 48 contiguous states of United States or Alaska who maintains cultural identification through tribal affiliation or community recognition.
- UOf undeterminable race. Of Untold mixture.
- WCaucasian(not Hispanic or Latino)
Height
Weight
Hair Color
Eye Color
Have you even had an administrative finding of Abuse, Neglect or Theft? If "Yes", give full details state. Continue on back if more space is needed.
- Yes
- No
Full Details
Have you ever been convicted of criminal offense other than minor traffic violation(do not include convictions that have been expunged, sealed or adjudicated delinquent)? If "Yes", give full details of each offense and the state in which convicted. Continue on back if more space is needed.
- Yes
- No
Full Details
Match Criteria: Please select checkboxes that match your skills and preferences.
- Children with Disabilities Experience
- Dementia Experience
- Hospice Experience
- Incontinence Experience
- Insured Automobile
- OK with Client Smoking
Tranfers
- Gait Belt Experience
- Hoyer Lift Experience
Pets
- OK with Cats
- OK with Dogs
Education & Training
- High School
- College
- Post Graduate
School
Degree Received
Certifications & Credentials: Please check all that apply
- Car Insurance
- Chest X-Ray
- CNA License
- CPR Certification
- Driver’s License
- First Aid Certification
- LPN License
- RN License
- State ID Card
- Tuberculosis Test
Other Skills and Qualifications
Employment History
Employer
Date Employed
Supervisor
Supervisor Phone Number
Company Address
Resume & Credentials
Upload your Resume
Max. file size: 50 MB.
Upload your credentials
Drop files here or

Accepted file types: jpg, pdf, doc, Max. file size: 50 MB.
References
Name
First Name Last Name
Job title
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
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(773) 588-4000
faxes@serenityhhc.com
6640 W. Touhy Ave.
Niles, IL 60714
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