Join The Team Are you interested in working with us Harmony Home Care Services? Please fill in the form below and we will contact you back. You may download the hiring form here. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstMiddleLastEmail *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSSN *DOB *Have you lived in the state of North Carolina for the past five (5) years? *YesNoIf no, please list the states that you have resided:Do you have a drivers license? *YesNoIf no, what is your means of transportation to work?Driver's license number:State of issue:Expiration date:Date Available:Desired Pay:HourlySalaryPOSITION APPLIED FOR:Personal Care AssistantCNAOtherEMPLOYMENT DESIRED:Full-TimePart-TimeSeasonalEmployment EligibilityAre you legally eligible to work in the U.S.? *YesNoHave you ever been convicted of a felony? *YesNoIf yes, please explain:Have you ever worked for this employer? *YesNoIf yes, start and end dates:EducationHighest level completed:High SchoolGEDCollegeCollege:City/State:From:Graduate?YesNoTo:Degree:Additional Information:Previous EmploymentEmployer 1:Company / IndividualEmailPhoneAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStarting Pay:HourlySalaryJob Title:Ending Pay:HourlySalaryResponsibilities: (List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company)From:To:Reason For Leaving:Employer 2:Company / IndividualEmailPhoneAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStarting Pay: HourlySalaryJob Title:Ending Pay:HourlySalaryResponsibilities: (List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company)From: To:Reason For Leaving:Employer 3:Company / IndividualEmailPhoneAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStarting Pay: HourlySalaryJob Title: Ending Pay:HourlySalaryResponsibilities: (List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company)From: To:Reason For Leaving:ReferencesFull Name *Occupation:EmailRelationship:Years Known:Phone *Full Name *Occupation:EmailRelationship: Years Known: Phone *Full Name *Occupation:Email Relationship: Years Known: Phone *Military ServiceAre you a veteran?YesNoBranch:From:Type of discharge:Rank at discharge:To:If not honorable, please explain:Background Check ConsentAre you willing to consent to a background check? *YesNoNOTE: Background checks are required for this positionDisclaimerApplicant understands that this is an Equal Opportunity Employer and committed to excellence We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered. Please complete each section EVEN IF you decide to attach a resume. I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.Submit