Apply to be considered for our care team.

This application records the positions and schedules you are interested in. It does not represent a current vacancy or guarantee an interview, employment, assignment, hours, location, or schedule.

1Personal Information

Full legal name *Preferred namePhone number *Street address *City *State *ZIP code *Email address *

2Position Interest & Availability

Tell us what you would like to be considered for. These selections do not promise that a position, schedule, or assignment is currently available.

Position of interest *Preferred employment type *Preferred schedule *Date available *Primary county of interest *Schedule restrictions

3Education, Credentials & Experience

Education and specialized healthcare trainingCPR and other certificationsProfessional license or CNA registry detailsHealthcare skills and experience

410-Year Employment History

Add each employer from the past 10 years separately. If you had a period without an employer, explain it in the gap field instead of inventing an employer.

Employer 1

Employer/company name *City and state *Job title *Supervisor *Employer telephone number *May we contact this employer? *Start date *End date * I currently work hereReason for leaving *

Employment History Gap Explanation

5Optional Résumé

You may attach one résumé in PDF, DOC, or DOCX format. Maximum file size: 3 MB.

Upload Résumé — Optional

Résumé only.

Do not upload Social Security cards, driver’s licenses or identification documents, banking information, tax forms, medical records, or other sensitive onboarding documents.

6Registry Disclosure & CertificationHave you been convicted of a felony? *Do you have any substantiated findings of abuse, neglect, or misappropriation listed on the North Carolina Health Care Personnel Registry? *

I certify that the information provided is true and complete, including my employment history for the past 10 years and any gap explanation. I understand that false or misleading information may result in disqualification or termination. I authorize Val’s Home Health Care, Inc. to verify information, credentials, registries, references, and conduct required employment screenings. Employment is conditional pending satisfactory screening results.

I have read and agree to the applicant certification. *Electronic signature (type your full legal name) *

Val’s Home Health Care, Inc. is an Equal Opportunity Employer.