Employment Application

Apply for work today:

Please complete the following form to apply for a position.  Include details, past experience, etc in the comments section:

Name: *
E-mail: *
Address 1: *
Address 2:
City: *
State/Zip: *
Phone: *
-
Qualifications:
Do you possess a valid PA drivers license. Yes or No *
>> If no, please explain:
Please provide 3 work references or 6 personal references. Include names & phone numbers for each contact.
List any disabilities that may limit the work you are able to perform.
Other than minor traffic violations, have you ever been convicted of felony or misdemeanor infractions. If yes, please explain:
Type the characters you see herein the box below:

Services Provided

* Primary Residence Cleaning
* Companionship & Errand Services
* Transport to Appointments
* Hospital Discharge Assessment
* Minor Residential Repairs
* Grocery Shopping
* Planning & Preparing Meals
* Personal Care Assistance
* Weekly Linens & Laundry Services
* Alzheimer's/Dementia Care
* Medication Reminders
* Aging & Health Resources

Search This Site

Proud Member of the Better Business Bureau

PA HOME CARE Of Lancaster BBB Business Review