Careers

Fill out the form completely to apply for a position with ASK In Home Care.

Today's Date
Position Applying for*
Other Position*
Name*
First Middle Last
Current Address*
Street Address City State / Province / Region ZIP / Postal Code
Previous Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Home Phone*
Work Phone*
Cell Phone*
Emergency Contact*
First & Last Name Phone Number
Social Security Number*
Date of Birth*
MM
DD
YYYY
Valid Driver's License #*
State Issued*
Expiration Date
Do you have a vehicle?*
Have you ever submitted an application here before?*
When did you submit an application?*
Have you ever been employed here before?*
When were you employed here?*
Have you ever been convicted of a felony or Misdemeanor?*
Please explain the circumstances*

Vehicle Information
Make and Model of Vehicle*
Year of Vehicle*
Auto Insurance Company Name*
Policy Number*
Insurance Expiration Date*
Availability
Due to the nature of the business, no guarantee can be made as to the schedule or the amount of hours worked.
What date are you available to begin work?*
Date Format: MM slash DD slash YYYY
What time periods are you available? (Select all that apply)*
- Mornings
- Afternoons
- Evenings
- Overnights
- Weekdays
- Weekends
Please indicate the days of the week as well as the earliest and latest times that you are available for work.*
Day of the Week (e.g. Monday, Tuesday, etc) Shift Start Time Shift End Time

Add additional days using the plus sign.

Preferences
Please indicate the types of services which you are willing to provide.*
- Personal Assistant
- Companionship
- Meal Preparation
- Activities (games/crafts)
- Housekeeping (dust/vacuum)
- Laundry/Ironing
- Medication Reminders
- Errands/Shopping/Transportation
- Personal Care
- Dementia/Alzheimer's Care
Are you willing to provide service to a client with a pet?*
Which pets fo you prefer?*
Are you willing to provide service to a client that smokes?*
Job Related Skills
Describe any training or life skills you have that apply to caring for a senior:*
Describe any work history you have that would apply to caring for a senior:*
What do you like (or think you would like) most about working with older adults?*
What do you like (or think you would like) least about working with older adults?*
What personal rewards do you get from working with seniors?*
Education
*For employment our minimum education requirement is either a GED or High School diploma
Level of Education*
Do you have a GED or High School Diploma?*
Do you have a College Degree?*
Do you have any Vocational /Technical Training?*
In what area is your Vocational/Technical Training?*

Work History
**Your application will not be considered unless all questions in this section are answered. Since we will make every effortto contact previous employers, the correct telephone numbers of past employers are essential.
How Many Employers Have you Had?*
Most Recent Employer
Are you currently working for this employer?
Company Name*
City*
State*
Company Phone Number*
Start Date*
Date Format: MM slash DD slash YYYY
End Date*
Date Format: MM slash DD slash YYYY
Job Title*
Supervisor's Name*
Duties*
Monthly Salary*
Reason for Leaving*
Enter "Still Working Here" if you are still working at this job.
Second Most Recent Employer
Company Name*
City*
State*
Company Phone Number*
Start Date*
Date Format: MM slash DD slash YYYY
End Date*
Date Format: MM slash DD slash YYYY
Job Title*
Supervisor's Name*
Duties*
Monthly Salary*
Reason for Leaving*
Enter "Still Working Here" if you are still working at this job.
Third Most Recent Employer
Company Name*
City*
State*
Company Phone Number*
Start Date*
Date Format: MM slash DD slash YYYY
End Date*
Date Format: MM slash DD slash YYYY
Job Title*
Supervisor's Name*
Duties*
Monthly Salary*
Reason for Leaving*
Enter "Still Working Here" if you are still working at this job.
References (Do not include relatives)
Please add a minimum of three references. Your application will not be considered unless three references are provided. Since we will contact these references, please notify them in advance. If we are unable to reach all 3 references, you will be asked to provide additional references.
Reference Details*
Full Name Phone Number Best Time of Day to Call Relationship Number of Years Known
Upload your resume (Optional)
Accepted file types: pdf, doc, docx.
CERTIFICATION AND RELEASE: I certify that I have read and understand the applicant note on page one (1) of this form 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 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 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 release this company from any liability, which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that this application is not a contract of employment. My employment is contingent upon confirmation of credentials and successful completion of drug test or criminal background check. I also understand that if hired, regardless of any oral presentations to the contrary, the employment/contractual relationship between ASK In Home Care, Inc. and myself is terminable at-will, so that both the company and I remain free to choose to end out work relationship at any time for any or no reason. Any changes in this employment relationship must be made in writing. My signature below acknowledges that I have read, understand, and agree to the above disclosure. I also understand that due to the nature of the business, no amount of work can be guaranteed.
Print Full Name*

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ASK In Home Care, Inc - Antioch
5179 Lone Tree Way
Antioch, Ca 94531

ASK In Home Care, Inc - Danville
4115 Blackhawk Plaza Circle, STE 100
Danville, CA 94506
Phone: (925)718-6ASK or
Phone: (925)718-6275

Email: admin@emails4ask.com
Telephone: (925) 289-9134
Fax: (925) 553-7432

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First & Last Name	Phone Number

Day of the Week (e.g. Monday, Tuesday, etc)	Shift Start Time	Shift End Time

Full Name	Phone Number	Best Time of Day to Call	Relationship	Number of Years Known

Vehicle Information

Availability

Preferences

Job Related Skills

Education

Work History

Most Recent Employer

Second Most Recent Employer

Third Most Recent Employer

References (Do not include relatives)

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