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Home
/ Careers
Careers with Azalea
Category of Employment
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Management
Clerical
Experienced Caregiver
CNA
RN
LPN
Other
Pay Expected:
Please check the box next to each item that you currently have. If contacted to schedule an interview you will be required to bring the items that pertain to your position and are required by the State of GA.
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Have valid Driver's License
Have your own vehicle
Have auto insurance (minimum of liability)
Have flexible hours
Can be available every other weekend
Have high school diploma or G.E.D.
Can pass criminal background check
Can pass drug test
Valid Driver's License (IF you Drive)
Current CPR Certification
Current First Aid Certification
Current CNA Certification
TB Skin Test or Chest X-Ray (within last 12 months)
Recent Driving Record from Department of Motor Vehicles (Last 30 Days)
3 Professional References
Clear Background Check
Title:
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Mr
Mrs
Ms
First Name:
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Last Name:
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Address Line 1:
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Address Line 2:
City:
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State:
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Zip:
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County of Residence:
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Previous Address:
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Contact Telephone 1:
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Contact Telephone 2:
Email: *NOTE: You must enter a valid email address or your application will not be received.
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Best time to Contact:
Morning
Afternoon
Evening
Weekends
Emergency Contact:
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Emergency Contact Address (street, city, state, zip):
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Emergency Contact Phone 1:
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Emergency Contact Phone 2:
Emergency Contact Relationship:
Have you worked for Azalea Home Care previously?
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Yes
No
If yes, when? (month and year)
Are you Legally eligible to work in the U.S.?
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Yes
No
Have you ever been convicted of a felony?
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Yes
No
If yes, explain:
Tell us about yourself and why you want to join our TEAM:
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How did you hear about us?
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Available to Start:
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Are you looking for:
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Full-time
Part-time
When are you available?
Morning
Afternoon
Weekends
Evening
Overnight
Weekday Hours Available:
Yes
No
"I acknowledge that if hired, my work schedule will be based on the above availability"
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Yes
No
In what counties are you available to work?
Do you have any appointments, vacations, etc. scheduled within the next 6 months that would prevent you from working? If so, please explain.
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Previous Employer 1:
Address
City
State
Zip Code
Phone:
Supervisor:
Start Date:
End Date:
I am "still" employed with this company:
Yes
No
Starting Pay Rate:
Ending Pay Rate:
Present or Final Position:
Job Duties:
Reason for Leaving:
May we contact this employer?
Yes
No
Previous Employer 2:
Address, City, State, Zip
Supervisor:
Start date:
End date:
Starting and Ending Pay Rate:
Position and Job Duties:
Reason for leaving:
High School Diploma:
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Yes
No
Name of School:
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State:
GED Certificate:
Yes
No
City:
Name of School:
City:
Vocational or Business School:
Yes
No
Name of School:
City:
Some College:
Yes
No
Name of School:
City:
College Degree:
Yes
No
Name of School:
City:
Graduate Degree:
Yes
No
Name of School:
City:
List Licenses and Certifications with Issuing state and expiration dates:
What languages do you speak?
Additional Skills:
Computer
Fax
Copier
Type
Switchboard
Calculator
10-Key Adding Machine
Software
Microsoft Windows
Macintosh
Other:
Personal reference 1: (name, telephone, address)
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Personal reference 2: (name, telephone, address)
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State:
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Personal reference 3: (name, telephone, address)
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I certify that I am at least 18 years of age, a legal resident of the U.S., have a clear criminal background history and driving record, am able to pass random drug screening tests, have at least 5 years of relevant work experience and have never been convicted of Abuse or Neglect of any kind.
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I agree
I do not agree
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