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CareStaf Application

CareStaf Application

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  • Please choose all areas that apply

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  • If you are not a licensed nurse or caregiver, just enter the number 1 in this box.

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  • CRIMINAL BACKGROUND
    Answering yes to any of the questions below, will not necessarily disqualify you from consideration for employment.

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  • EMPLOYMENT HISTORY
    Please list below all employers for the last three years.

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  • Previous Employment #1

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  • Previous Employment #2

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  • VETERAN STATUS

    Title 38, United States Code, Section 4212(d) and PL 105-339, require that federal contractors report at least annually the numbers of existing employees who are: 1) special disabled veterans, 2) veterans of theVietnam era, and 3) other protected veterans.

    To help us comply with these requirements please complete the following questions. Access to this information will be limited to individuals assisting with the auditing process and completion of required reporting.

  • A veteran of the U.S military, ground, naval, or air service, any part of whose service was during the period August 5, 1964 through May 7, 1975, who (1) served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active dity because of a service-connected disability. Vietnam Era Veteran also includes any veteran of the U.S. military, ground, naval, or air service who served in the Republic of Vietnam between February 28, 1961 and May 7, 1975. Any other veteran who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, other than a special disabled veteran, of the vietnam era, or recently separated veteran.

  • Any veteran who served on active duty during the three year period beginning on the date of such veteran's discharge or release from active duty.

  • A veteran who served on active duty in the U.S. military ground, naval, or air service and (1) who was discharged or released of a service-connected disability, or (2) who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) for certain disabilities under laws administered by the Department of Veterans Affairs (i.e., disabilities rated at 30 percent or more, or at 10 or 20 percent if the veteran has been determined to have a serious employment handicap.)

  • Contract & Signature

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  • CareStaf is an equal employment/affirmative action employer. We do not discriminate against any applicant or employee based on race, sex, color, religion, creed, national origin, age, sexual orientation, disability or veteran's status or any other prohibited reason. We have a diverse client base and offer opportunities to all qualified care givers.

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