Enjoy a Rewarding Career Today

We appreciate your interest in working with us as a caregiver. Working for Reliable Supportive Home Care is a rewarding opportunity for those who are committed to the values of changing lives and giving hope.

We give our employees that value and respect that they deserve. They are the keys to success for keeping our clients comfortable, happy and well cared for.

How to Apply

Reliable Supportive Home Care Employment Application

If you are interested in starting your career with Reliable Supportive Home Care please fill out the form below and submit it to us.

Application For Employment Form

Mission Statement:

The mission of Reliable Supportive Home Care LLC is rooted in a set of core values and our
unique purpose is draped around reliability and an excellent support team of empathetic Direct
Support Professionals and a phenomenal heritage of great customer service and excellence.

Please check off the qualifications for employment: Required

Are you at least 18 years of age?

Are you a U.S. citizen or approved to work in the United States?

Will you concent to a criminal background check?

Do you have reliable transportation?

Are you comfortable assisting men and women with toiletry needs?

Do you have a reliable means of communication?(i.e. house phone or cell phone)

Are you willing to undergo a PPD (tuberculosis) skin testing?

This application must be completed in its entirety with a verification signature and date.
A resume may be attached to further expand on qualifications, but it does not absolve
the requirement of a completed application.

Today's Date

First name

Last name

Middle Initial

Home Address

Address Line 2

City

State

Zip

Phone Number

Email Address

What Position Are You Applying For?

Work Availability

Temporary

Part Time

Full Time

What Date Can You Start?

Acceptable Salary Range

How Did You Hear About Reliable Supportive Home Care?

Have You Ever Been Employed By Reliable Supportive Home Care?

Yes

If Yes, Please Give Entity and Dates:

Including work and volunteer experience, how many years of experience do you have working with individuals with disabilities?

Do You Have The Legal Right To Work In The United States? Required

Yes

Do You Have Documention To Support The Above Statement

Yes

Do You Have A Valid Driver's License? Required

Yes

What State Is Your License From?

Military Background

Are You A Member Of The Armed Services?

Yes

What Branch Of The Military Did You Enlist Into?

What Was Your Military Rank When Discharged?

How Many Years Did You Serve In The Military?

What Military Skills Do You Possess That Would Be An Asset For This Position?

Have You Resided in Pennsylvania For The Last Two Years?

Yes

If Not, When Did You Move To Pennsylvania?

Have You Ever Been Investigated, Disciplined, or Discharged By An Employer For Client Abuse or Neglect?

Yes

If Yes, Please Explain:

Have You Ever Plead Guilty To Or Were Convicted Of A Crime?

Yes

If Yes, Please Explain

Education

High School

High School Name

High School Address

City

State

ZIP

Years Completed

Graduated?

Yes

Undergraduate College

Undergraduate College Name

Undergraduate College Address

City

State

ZIP

Years Completed

Graduated?

Yes

Major

Degree

Graduate / Professional

Graduate/ Professional College Name

Graduate/ Professional College Address

City

State

ZIP

Years Completed

Graduated?

Yes

Major

Degree

Work History

1) Employer Name

1) Job Title

1) Supervisor Name

1) Street Address

1) City

1) State

1) ZIP

1) Employer Telephone

1) Dates Employed

1) Reason For Leaving

2) Employer Name

2) Job Title

2) Supervisor Name

2) Street Address

2) City

2) State

2) ZIP

2) Employer Telephone

2) Dates Employed

2) Reason For Leaving

3) Employer Name

3) Job Title

3) Supervisor Name

3) Street Address

3) City

3) State

3) ZIP

3) Employer Telephone

3) Dates Employed

3) Reason For Leaving

Professional License and/or Certifications

List Any Professional License(s)

License(s) Number(s)

Has Your Professional Liense Ever Been Suspended or Revoked?

Yes

If Yes, Please Explain

List Any Relevant Certifications

Skills and Qualifications

Please list any other qualifications, professional organizations, and/or volunteer experiences that are applicable to the position for which you are applying for. you may exclude and whose name would indicate the race, religion, creed, color, national origin or ancestry of it's members

References

Reference 1 Name

Relationship

Address

City

State

ZIP

Reference 1 Phone Number

Reference 2 Name

Relationship

Address

City

State

ZIP

Reference 2 Phone Number

Reference 3 Name

Relationship

Address

City

State

ZIP

Reference 3 Phone Number

Criminal Background Disclosure

I also, understand that prior to an offer of employment at Reliable Supportive Home Care LLC will conduct a criminal background check within the State of Pennsylvania and search the nurse aide registry and employment misconduct registry to determine eligibility for employment.

Your Signature

Date

Witnessed By

Date

Authorization and Release of Information

I hereby give Reliable Supportive Home Care LLC, and any of its affiliates and divisions, the right to thoroughly investigate my past employment, education, police record, activities, and I release from all liability all persons, companies, and corporations supplying such information. I indemnify RSHC against any liability which might result from conducting such an investigation. I understand that any false answers or statements or implications made by me in this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between RSHC and myself for either employment, contract work, or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon RSHC unless made in writing by the President and Chief Executive Officer. I acknowledge by signing below that I fully understand that I am applying to the agency as a contracted Lifesharing provider and not one particular home or individual.

Your Signature

Date

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Thank you for your application. We will review it and get in touch with you soon!

"We Change Lives and Give Hope"

3324 Route 940, Suite 105

Mt. Pocono, Pennsylvania

Reliable Supportive Home Care

Enjoy a Rewarding Career Today

How to Apply

Application For Employment Form