Apply for Barren County/Glasgow area - Empower Lives as a Home Caregiver! - WCSC Kentucky, LLC dba Home Instead Bowling Green

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Apply for Barren County/Glasgow area - Empower Lives as a Home Caregiver!

Hello and thank you for your interest in Home Instead. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 1861 Westen Street, Bowling Green, Ky 42104 . Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at 270-842-7540.

Summary
Title:	Barren County/Glasgow area - Empower Lives as a Home Caregiver!
ID:	1235292418
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Opt-In Confirmation
	I authorize recruiters from WCSC Kentucky, LLC dba Home Instead Bowling Green to send text messages from 8447942037 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.
Attachments
Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

	- or Upload from:


Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Additional Information

* How did you hear about Home Instead?

If applicable, please specify:

CAREGiver Prescreen Questions

* Do you have at least 3 years of driving experience?

	Yes
	No

* Do you have a valid driver's license?

	Yes
	No

* Do you have valid auto insurance?

	Yes
	No

* Are you able to lift, push or pull up to 25 pounds?

	Yes
	No

* Do you have reliable transportation?

	Yes
	No

* Have you ever been convicted of a felony?

	Yes
	No

* Are you currently employed?

	Yes
	No

Release & Authorization for Criminal Background Check

Background Check Notice and Disclosure

WCSC Kentucky, LLC, d/b/a an independently owned and operated Home Instead franchise ("the Company"), is providing you with notice that it may order a consumer report may be obtained for employment purposes as part of the pre-employment background investigation and at any time during your employment.

The Company may order an “investigative consumer report.” Such reports typically include information from personal interviews, most commonly from an applicant’s prior employers and references. Should an investigative consumer report be requested, you will have the right to request a complete and accurate disclosure of the nature and scope of the investigation requested and a written summary of your rights under the Fair Credit Reporting Act.

The background report may contain information concerning your character, general reputation, personal characteristics, mode of living and criminal history. Information may be obtained from private and public record sources, and for investigative consumer reports, from personal interviews as noted above.

Authorization for Procurement of Consumer Report

Pursuant to the federal Fair Credit Reporting Act, I authorize WCSC Kentucky, LLC, d/b/a an independently owned and operated Home Instead franchise ("the Company and its designated agents and representatives to order a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee.

I understand that, to the fullest extend allowed by law, information contained in my employment application or otherwise disclosed to the Company by me in the hiring process or during my employment may be utilized for the purpose of obtaining consumer reports.
I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; professional credentials and licenses and any other public records. I authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have.
I authorize and request any present or former employer, school, law enforcement and all other federal, state and local agencies; federal, state and local courts, financial institution or other persons having personal knowledge of me to furnish the Company or its designated agents with any and all information in their possession regarding me in connection with an application of employment.
I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s rights will be provided to me.
If hired, or if already employed, this authorization shall remain on file and shall serve as an ongoing authorization for the Company to obtain consumer reports, at any time during my employment, for employment purposes. Further, if hired, or already employed, my signature below authorizes the Company to supply my employment history with the Company to a consumer reporting agency.
My signature below signifies my receipt and understanding of the "Background Check Notice and Disclosure" and authorizes the Company to obtain consumer reports regarding me.

* Social Security Number

* Date of Birth

* Driver's License Number

* Issuing State

* Signature (type name)

* Date

BID- Background Information Disclosure 4.2023

BACKGROUND INFORMATION DISCLOSURE (BID)

INSTRUCTIONS

The Background Information Disclosure for Employees gathers information required to conduct caregiver background checks for prospective and existing employees and contractors. This form may also be used to conduct background checks for students and volunteers that are expected to have regular and direct contact with clients. Caregiver Background Checks are required for prospective and existing employees and contractors of entities. An entity may not employ or contract with an individual to serve as a "caregiver," if the individual has certain governmental findings or criminal convictions affecting eligibility. A person who provides false information on this form may be declined employment on the basis of dishonesty. Failure to complete this form may result in denial or termination of your employment, contract or service agreement.

* Check the box that applies to you.

	Applicant/Employee
	Contractor
	Student/Volunteer
	Other

If other, please specify.

* Full Legal Name (First, Middle, and Last)

Other Names (including prior to marriage)

Position Title (applied for or existing)

* Birth Date (MM/DD/YYYY)

Sex

	Male
	Female

* Home Address

* City

* State

* Zip Code

Business Name and Address-Employer (Entity)

Answering "NO" to all questions does not guarantee employment, a contract, or service agreement.

SECTION A-DISCLOSURES

* 1. Do you have any criminal charges pending against you, including in federal, state, local, military, and tribal courts?

	Yes
	No

If yes, list each charge, when it occurred or the date of the charge, and the city and state where the court is located.
You may be asked to supply additional information, including a copy of the criminal complaint or any other relevant court or police documents.

* 2. Were you ever convicted of any crime anywhere, including in federal, state, local, military, and tribal courts?

	Yes
	No

If Yes, list each crime, when it occurred or the date of the conviction, and the city and state where the court is located.
You may be asked to supply additional information including a certified copy of the judgment of conviction, a copy of the criminal complaint, or any other relevant court or police documents.

* 3. Has any government or regulatory agency (other than the police) ever found that you committed child abuse or neglect?

	Yes
	No

Provide an explanation below, including when and where the incident(s) occurred.

* 4. Has any government or regulatory agency (other than the police) ever found that you abused or neglected any person or client?

	Yes
	No

If Yes, explain, including when and where it happened.

* 5. Has any government or regulatory agency (other than the police) ever found that you misappropriated (improperly took or used) the property of a person or client?

	Yes
	No

If Yes, explain, including when and where it happened.

* 6. Has any government or regulatory agency (other than the police) ever found that you abused an elderly person?

	Yes
	No

If Yes, explain, including when and where it happened.

* 7. Do you have a government issued credential that is not current or is limited so as to restrict you from providing care to clients?

	Yes
	No

If Yes, explain, including credential name, limitations or restrictions, and time period.

SECTION B-OTHER REQUIRED INFORMATION

* 1. Has any government or regulatory agency ever limited, denied, or revoked your license, certification, or registration to provide care, treatment, or educational services?

	Yes
	No

If Yes, explain, including when and where it happened.

* 2. Has any government or regulatory agency ever denied you permission or restricted your ability to live on the premises of a care providing facility?

	Yes
	No

If Yes, explain, including when and where it happened and the reason.

* 3. Have you been discharged from a branch of the US Armed Forces, including any reserve component?

	Yes
	No

If Yes, indicate the year of discharge and nature of discharge (ex: honorable or dishonorable):

* 4. Have you resided outside of Kentucky in the last three (3) years?

	Yes
	No

If Yes, list each state and the dates you resided there.

* 5. Have you had a caregiver background check done within the last four (4) years?

	Yes
	No

If Yes, list the date of each check, and the name, address, and phone number of the person, facility, or government agency that conducted each check.

* I consent to electronic communication from, AccurateNow, background check company for We Care Senior Care, Inc dba Home Instead.

	Yes
	No

Read and initial the following statement.

* I have completed and reviewed this form (BID) and affirm that the information is true and correct as of today's date.

* Person Completing This Form

* Date Submitted

Applicant Note & Certification

APPLICANT NOTE

WCSC Kentucky, LLC is an independently owned and operated Home Instead® franchise 1861 Westen Street, Bowling Green, KY 42104 270-842-7540.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

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