Home » Pre-Employment Application Pre Employment Application "*" indicates required fields Do you have a smartphone with internet access?*YesNoWill you be able to pass criminal background check?*YesNoCan you pass a drug screen test if given today?*YesNoDo you have a checking or savings account?*YesNoCan you obtain a checking or savings account?*YesNoHigh School diploma*YesNoG.E.D*YesNoAre you a CMA or CNA?*YesNoIf yes, which one?*CMACNAAre you a RN or LPN?*YesNoIf yes, which one?*RNLPNWho referred you to Kellie’s Sitting Service? Are you currently working?YesNoList other agency here: Work Schedule: (list days: Monday, Tueseday, etc...) Shifts: Are you related to anyone currently working for Kellie’s Sitting Service? Days Available to work Hours Available to work Work Location Area Request Name* Date MM slash DD slash YYYY Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone number:*Mobile number:*Other phone number:Work Experiences (list 3 verifiable references)EmployerFrom:To:SupervisorPositionTelephone numberReason for leaving Add Removecheckbox1 I understand that if my references are verified then I will be called in for a drug test and a criminal background will be done on this Pre-Employment Application. checkbox2 NO TRAINING UNTIL BANKING INFORMATION HAS BEEN RECEIVED AND IS IN HUMAN RESOURCES. All bank information must be printed, no hand written information will be accepted. The acceptable documents for verification of banking information is a voided check or printed information on bank letterhead with the account number, routing number and status (checking/saving) account. checkbox3 Also, my signature below, acknowledges that I am fully aware that in any emergency situation (hurricanes, etc.) I am required to work the schedule assigned to me. My signature below authorizes Kellie’s Sitting Services, Inc. to obtain information on my employment history.SignatureDate MM slash DD slash YYYY Effective 1/21/11, Program Director, Rena’ Sanders must sign this form confirming that pay rate has been verified and discussed for potential employee.CAPTCHA
