Caregivers

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Serene Care Solutions

Caregivers

Overview Application

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Professional / Personal References (Must Complete)

Persons who can furnish information about job performance or personal information about you.

1)

General Questions


1) Have you ever applied for employment with this Agency? *



2) How many hours a week are you available for work? *


3) Are you legally eligible for employment in the United States? *



4) How did you learn of our organization? *



5) Are you willing to work *




Background Check & Reference Contact Consent



As part of the hiring process, the Agency may conduct a background check and contact references to verify the information provided in your application and to assess your qualifications for employment.

By signing below, you acknowledge and agree to the following:

I, ____________________, authorize the Agency to conduct background checks, which include OIG and criminal history, as permitted by law.

I, ____________________, give permission for the Agency to contact the professional and/or personal references I have provided.

I, ____________________, understand that this information will be used solely for employment purposes and will be kept confidential.

Applicant Signature: __________________
Date: February 4, 2026