Parkinson's Specialty Care

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Employment

For employment opportunities, please contact Stephanie Smith  stephanie@pscmn.com at 612-239-7158.

 

Parkinson’s Specialty Care
8085 Wayzata Blvd. Suite 105
Golden Valley, MN 55426

    1

    Caregiver Job Application

    2

    Employment Desired

    3

    Education

    4

    Skills/Qualifications

    5

    Current Employment

    6

    References

    7

    Cover Letter & Resume

    Full Name *
    Address *
    Phone Number *
    E-mail *
    Birth Date *
    Are You a U.S. Citizen? *
    YesNo
    Do You Own A Car? *
    Do You Have A Drivers License? *
    YesNo
    Distance Willing To Travel? *
    What Languages Do You Speak?

    Current Occupation *
    Years Experience
    Position Applying For *
    Date You Can Start *
    Other Position Not Listed
    Salary Desired *
    Convicted Of A Fellony? *
    YesNo
    If So Please Explain
    What Shifts Are You Available? *
    Disease Monday Tuesday Wednesday Thursday Friday Saturday Sunday
    6a-9a Yes Yes Yes Yes Yes Yes Yes
    9a-12p Yes Yes Yes Yes Yes Yes Yes
    12p-3p Yes Yes Yes Yes Yes Yes Yes
    3p-6p Yes Yes Yes Yes Yes Yes Yes
    6p-9p Yes Yes Yes Yes Yes Yes Yes
    9p-midnight Yes Yes Yes Yes Yes Yes Yes
    Overnight Yes Yes Yes Yes Yes Yes Yes
    Live-In Yes Yes Yes Yes Yes Yes Yes

    I have my GED
    YesNo
    High School
    Number of Years Attended
    Graduated? *
    YesNo
    College
    Number of Years Attended
    Graduated? *
    YesNoSome College
    Area of Study/Degree
    Graduate School
    Number of Years Attended
    Graduated? *
    Yes
    Area of Study/Degree
    Trade School/Other
    Number of Years Attended
    Graduated? *
    Yes
    Area of Study/Degree

    Skills *
    Qualifications *

    Current Employment

    Current Employer *
    Position *
    Salary
    Start Date
    May We Contact?
    YesNo

    Previous Employment

    Previous Employer *
    Position *
    Salary
    Reason for Leaving?
    Start Date
    End Date
    Previous Employer *
    Position *
    Salary
    Reason for Leaving?
    Start Date
    End Date

    Reference 1 *
    Relationship *
    Years Acquainted *
    Phone *
    E-mail *
    Reference 2 *
    Relationship *
    Years Acquainted *
    Phone *
    E-mail *
    Reference 3
    Relationship
    Years Acquainted
    Phone
    E-mail

    Cover Letter
    Resume

    Send Application

    By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed by one of our affiliates, my employement may be terminated at any time.

    In consideration of my employment, I agree to conform to the hired company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

    I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. 

    Signature

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