• Providing meaningful work opportunities for home health care professionals who are compassionate, pursue excellence, and are reliable.

    Committed to Excellent and Quality Care.

  • Application Form

  • We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, medical condition, national origin, or marital status.

  • Personal Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • General Information

  • Position(s) Applied For*
  • Job Type Applying For?*
  • Employment Status Desired*

  • Availability and Preferences

    Please note: ETHC cannot guarantee work or give assurance that you will only be offered cases within the preferences that you have selected. This information will help us try to accommodate your requests.
  • Rows
  • Are you willing to cover holidays?*
  • Are you willing to cover call-outs?*
  • Are you willing and able to work in homes with dogs?*
  • Are you willing and able to work in homes with smokers?*
  • Are you able to work cases where public transportation may not be available?*
  • Have you been employed with Eden Touch Home Care before?*
  • Can you provide documentation of a driver's license and auto insurance?*
  • Have you ever been convicted of, or plead guilty or no contest to, a misdemeanor or felony in this state or any other?*
  • If considered for hiring, will you agree to a background check?*
  • If considered for hiring, will you agree to a driver's license report?*
  • If considered for hiring, will you agree to a drug screening?*

  • Employment Verification

  • Are you a U.S. citizen?*
  • If you are not a U.S. citizen, are you authorized to work in the U.S.?*

  • Educational Background

  • Do you have a High School Diploma or GED?*
  • Additional Education? (vocational, undergraduate, etc.)*

  • Training and Certification

  • Do you have a valid HHA license?*
  • Rows
  • CPR Certified?*
  • IV Certified?*

  • Employment History

  • Instructions:
    Please list your 2–3 most recent employers covering at least the past 5 years. If you have fewer than 5 years of work history, please explain any gaps (e.g., school, caregiving for a family member, unemployed).

    You must provide at least two contacts we can verify. If you do not authorize us to contact two former employers, you will be asked to provide a professional reference instead.

    Please note that we will contact the references you provide to verify your work history.

  • How many previous employers would you like to list?
  • Start Date:*
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  • End Date:*
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  • Hours Worked*
  • Format: (000) 000-0000.
  • Start Date:*
     - -
  • End Date:*
     - -
  • Hours Worked*
  • Format: (000) 000-0000.
  • Start Date:
     - -
  • End Date:
     - -
  • Hours Worked
  • Format: (000) 000-0000.

  • Professional References

    Since you have listed fewer than two employers we are authorized to contact, please provide a professional reference. This should be someone who can speak to your work ethic, experience, or qualifications — such as a former supervisor, colleague, teacher, or mentor.
  • Format: (000) 000-0000.

  • Integrity Questions

  • Instructions: Answer yes or no to the following questions (explain "yes" answers with the date(s) and detail(s) of each answer in the section below)

  • Have you ever worked under a different name?*
  • Have you ever been reprimanded, suspended, or discharged from a job due to violent behavior at work?*
  • Have you ever been reprimanded, suspended, or discharged from a job due to abuse/neglect of clients or children?*
  • Have you ever been investigated for suspicion of abuse/neglect of clients or children by a government agency?*
  • Have you ever been involved in a lawsuit, either directly or through an employer, alleging negligence or malpractice?*
  • Have you ever been sanctioned or excluded from participation in federal or state healthcare programs or surrendered / lost your professional license for an offense that could lead to sanction or exclusion?*
  • Have you ever had disciplinary action filed against your professional license or CNA / HHA certification in any state?*
  • Have you ever been reprimanded, suspended, or discharged from a job for any reason?*

  • Applicant Statement: By signing below, I verify that all information provided about my background, education, licensure, employment history, and skills is true, complete, and correct. I authorize ETHC Home Health Care to independently verify any information provided by me in the hiring process and if hired, throughout my employment. ETHC may specifically contact any reference, learning institution, current or previous employer of mine whether disclosed in my employment application or not. I understand that any offer of employment may be withdrawn or terminated if discrepancies are found.

  • Clear
  • Date*
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  • Should be Empty: