Entrusted Hearts by Baptist Village, BVC's home health care services company, seeks personal care aides to serve at all Entrusted Hearts locations (Lawton, Oklahoma City and Tulsa areas). Full and part-time shifts are available. Certification is a plus, but not required.

Tasks include, but are not limited to:

* Assistance with personal care

* Assistance with ambulation

* Meal preparation

* Housekeeping

* Shopping/errands

Step 1 of 7 - Personal Information

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Application Date*

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Date Available to Start Work*

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Personal Information

Name*

First Last

Applicant's Address*

Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Primary Phone*

Secondary Phone

Location Applying For*

AdaBroken ArrowClevelandCordellElk CityEnidHoney CreekLake TexomaLawton - Home HealthMiamiOklahoma CityOkmulgeeOwasso

Position(s) Applied For*

Rate of Pay Desired*

Position Type*

Full-time

Part-time

Shift*

Please indicate hours of availability.

How did you learn about this position?*

Please choose oneCurrent employee referralBaptist Village websiteOnline job siteOther

If referred by a current employee, please tell us their name so we can thank them.*

Please write N/A if not referred by current employee.

Are You 18 Years of Age or Older?*

Yes

Are You a U.S. Citizen or Resident Alien with a Visa Allowing You to Work?*

Yes

Have You Ever Applied to This Company Before?*

Yes

When did you last apply?

MM slash DD slash YYYY

Are You Related to Anyone Currently Working at Baptist Village Communities?*

Yes

Name of Related Person

Church Member*

Yes

Name of Church

Do you use tobacco, illegal drugs or alcoholic beverages?*

Yes

If yes, please specify

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References

(do not include relatives or former employers)

Name and Occupation*

Address*

Phone Number*

Name and Occupation*

Address*

Phone Number*

Name and Occupation*

Address*

Phone Number*

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Education and Training

Name of High School*

Location*

Grade Completed*

Year and Degree*

Name of College

Location

Year Completed

Year and Degree

Other Education/Training

Location

Grade/Year Completed

Year and Degree

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Employment and Record

(list last or present position first) If any breaks or gaps in employment exist, please briefly explain below.

Employer 1*

Address*

Supervisor

Phone*

Date Employed From*

MM slash DD slash YYYY

Date Employed To*

MM slash DD slash YYYY

Starting Salary Range*

Ending Salary Range*

Position and Duties*

Employer 2

Address

Supervisor

Phone

Date Employed From

MM slash DD slash YYYY

Date Employed To

MM slash DD slash YYYY

Starting Salary Range

Ending Salary Range

Position and Duties

Employer 3

Address

Supervisor

Phone

Date Employed From

MM slash DD slash YYYY

Date Employed To

MM slash DD slash YYYY

Starting Salary Range

Ending Salary Range

Position and Duties

Employer 4

Address

Supervisor

Phone

Date Employed From

MM slash DD slash YYYY

Date Employed To

MM slash DD slash YYYY

Starting Salary Range

Ending Salary Range

Position and Duties

Employer 5

Address

Supervisor

Phone

Date Employed From

MM slash DD slash YYYY

Date Employed To

MM slash DD slash YYYY

Starting Salary Range

Ending Salary Range

Position and Duties

If your former employment references, education or military service are under a name other than indicated on front of application, please indicate:*

(If not applicable, put N/A)

May we contact your present employer at this time?*

Yes

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Professional Licenses and/or Certification

Type

Organization or State

Date Issued

MM slash DD slash YYYY

Number

Verification

Type

Organization or State

Date Issued

MM slash DD slash YYYY

Number

Verification

Type

Organization or State

Date Issued

MM slash DD slash YYYY

Number

Verification

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Office Skills

Please list all computer/software programs you are experienced in*

Example: Word, Excel, Outlook, PowerPoint, Publisher, Access, etc...

Typing speed wpm*

Writing/Editing*

Fair

Good

Excellent

Office Equipment

(If not applicable, put N/A)

Why are you applying for a position in this ministry with senior adults?*

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Employment Acknowledgment

(please read and sign)

Baptist Village Communities does not discriminate in its hiring decisions or in any other employment decision on the basis of race, color, sex, citizenship, national origin, veteran status, age or upon a physical or mental disability which is unrelated to the applicant's/employee's ability to perform the essential functions of the position.

As part of the application process, I voluntarily give Baptist Village Communities the right to make a thorough investigation of my past employment background and activities. I further agree to cooperate fully in such investigation. I hereby release from all liability and responsibility any and all persons, companies or entities which provide Baptist Village Communities with information or documents requested by Baptist Village Communities as part of the application process.

If I am hired by the company, I understand that my employment will be "at will," meaning either party - me or the company - will be able to terminate my employment at any time, with or without cause. I also understand that my employment may be terminated for any misstatement of fact appearing on, or omission of fact from, this application form.

Further, I understand that after I am given a conditional offer of employment, I may be required to undergo a physical examination as well as a background check screening as a prerequisite to my continued employment with the company. I hereby consent to take that physical examination and any such future physical examinations as are required by the company.

Finally, I understand that I, like every other employee of this company, will be required to complete an Employment Verification Form (I-9) within three (3) days of my employment. At that time, I will produce the documentation of my choosing which will satisfy the requirements stated on the I-9 form for proof of identity and eligibility for employment.

Signature*

First Middle Last

Employment Acknowledgement Date*

MM slash DD slash YYYY

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