Regal Home Care
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Employment Application

Join the Regal Home Care team. Fields marked * are required.

Your information

Your SSN is stored encrypted and used only for employment forms.

Address

Personal details

Direct deposit

Bank details are stored encrypted.

Position

Criminal history attestation (DOH-102, item 7)

I certify to the best of my knowledge and belief that (check only if it applies to you): I HAVE been convicted of a crime in New York State or any other jurisdiction, and/or I DO have a final finding of patient or resident abuse.

Weekly availability

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Education & certifications

High school

College

Graduate school

Business school

Training program

Employment history

Documents

Optional. Upload your resume, HHA/PCA certificate, or ID (up to 10 MB each).

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Signature

By signing below, I certify that the information in this application is true and complete.

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