Apply with us

Please complete all sections thoroughly and accurately. All information provided will be kept confidential. Fields marked * are required.

Warm Embrace is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Personal Information

Full legal name *
Street address *
City *
State *
Zip code *
Phone number *
Email address *

Emergency Contact

Name *
Relationship *
Phone *

Employment Eligibility

Are you legally authorized to work in the United States? *
YesNo

If hired, you will be required to provide documentation to verify your identity and authorization to work.

Do you have reliable transportation? (Required for most positions) *
YesNo

Do you have a valid driver’s license and current automobile insurance? (Required for positions involving driving) *
YesNo

Driver’s license #
License state
License expiration date

Position & Availability

Position applying for *

Are you seeking: *
Full-TimePart-TimePer Diem

Weekly availability — check each day you are available:
SundayMondayTuesdayWednesdayThursdayFridaySaturday

Preferred hours

Are you able to work weekends and holidays as needed? *
YesNo

Qualifications & Skills

Certifications (e.g., CNA, HHA, CPR/First Aid)

Caregiving experience levels:

Personal care (bathing, dressing, grooming)
NoneBasicIntermediateAdvanced

Meal preparation
NoneBasicIntermediateAdvanced

Housekeeping
NoneBasicIntermediateAdvanced

Companionship
NoneBasicIntermediateAdvanced

Transfers (e.g., Hoyer lift, stand pivot)
NoneBasicIntermediateAdvanced

Dementia care
NoneBasicIntermediateAdvanced

Alzheimer’s care
NoneBasicIntermediateAdvanced

Do you have experience with specific medical equipment? (e.g., oxygen, ventilators)

Background Information

Have you ever had a finding of abuse, neglect, or misappropriation of funds entered against you in any state registry? *
YesNo

If yes, please explain

Employment History

Please list your last two employers, starting with the most recent.

Employer 1 (most recent)

Company name *
Phone
Address
Supervisor’s name
Job title held
Dates of employment — from
to
Reason for leaving
Duties performed

May we contact this employer?
YesNo

Employer 2

Company name
Phone
Address
Supervisor’s name
Job title held
Dates of employment — from
to
Reason for leaving
Duties performed

May we contact this employer?
YesNo

References

Please provide three professional or personal references (not relatives).

Reference 1

Name *
Phone *
Relationship *

Reference 2

Name *
Phone *
Relationship *

Reference 3

Name *
Phone *
Relationship *

Applicant Certification

I certify that the information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that any misrepresentation or omission of information may result in the rejection of my application or, if hired, my termination.

I authorize Warm Embrace to investigate all statements contained herein and to contact my previous employers, references, and any other sources to verify the information provided, unless otherwise noted. I release all parties from any liability for any damage that may result from furnishing such information.

If hired, I agree to abide by all rules and regulations of Warm Embrace.

I have read and agree to the certification above.

Electronic signature — type your full legal name *
Date *