Apply Online with Align Home Health

Applicant Information
Driver License State

Align's 10 Questions

Live-Ins - Being a Live-In means several consecutive days of care where the Caregiver stays at the care recipient's home for the entire number of days.

Valid Certifications

Federal law requires to present certain documentation to verify their identity and United States citizen status or, if an alien, their legal authorization to work in the United States.

(You will be required to provide proof of both a valid driver's license and auto insurance upon hire)

Organization Telephone Contact Person Dates Worked May We Contact
Contact Person Telephone Position/Title Dates Known

Name Location Major Graduate? End Date
Name Location Graduate? End Date
Skills and Preferences

Criminal History
Notification of OBRA Abuse Check
According to the Omnibus Budget Reconciliation act of 1987, this agency is prohibited from employing anyone convicted of abusing, neglecting or mistreating clients or who has had a finding entered into the Bureau concerning abuse, neglect, or mistreatment of clients or misappropriation of their monies.
Additional Questions

Emergency Contact Information
Name Relationship Cell Phone Home Phone

I certify the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentation of facts will result in rejection from this application and/or discharge at any time during employment period. I authorize Align Home Health to verify any and all information contained within this application, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment.
I agree not to do business directly with any individual or business entity that Align Home Health has introduced to me or by entering into employment with such individuals or businesses.