Part-time job in Lakewood, Colorado


Job Application

This application is for a part-time personal caregiver for a physically disabled young woman. The location is in Lakewood, near Union and Alameda Streets. No smokers, please. We will complete a thorough background check, and reference check.

Don't hit your return button until you are ready to send, or it will send the form! (If this happens you can use the "back" arrow to go back to this page and keep working on it).

Upon receipt, your application will be reviewed and you will hear from us soon...... Sometimes the application doesn't work properly, contact us if you haven't heard from us within 2 business days. Thanks.

First name :
Last name :
Email address :
Daytime phone number:
Evening phone number:
Best time of day or night to call:
Street address:
Are you a smoker? (we are looking for a non-smoking Caretaker):
How did you find us?:
Why are you interested in this job and why do you feel that you're qualified for it?

What is your desired job and your desired hourly pay?

What high school did you attend (name and location). What year did you graduate? or did you complete your GED? 

If you attended trade school(s) please share their name(s) and their location(s). Also list certificate(s) that you completed and year. Please specify if the certificate is still current.   
If you completed any higher education (college) please list name(s) of institutions and their locations. Also list degree(s) and years of completion.
Please list and describe any relevant experience for this job (besides what you've already shared):
Please list specific skills that you have that relate to this job (that you haven't already mentioned):
Please share any volunteer experience you have by listing the (organization(s) you volunteered for, their location(s), your duties, and the dates that you volunteered. May we contact them? If yes, please share phone number:  
Job #1. What is your current job (or if you're not working, your most recent job)? Please name your job title and your employer.
Please list the location (city) of your current (most recent) job and your dates of employment.
What are/were your job duties?
Why did you leave this job?
May we contact your employer? If yes, what's the phone number?


Job #2. Please answer all of the same questions about the job that you had before this most recent job (Employer, job title, location, dates of employment, duties, why left, may we contact employer? employer phone number
Job #3. Please continue listing job information, going back 4 years from today's date. If you run out of space, you may use the box at the bottom of this application to list further jobs.


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Please share any other information that may be important:

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