Now Hiring

Now Hiring Live In & Hourly PCAs & Companions.

Thank you for your interest in Home Sweet Home Care Inc. We are seeking high-quality persons to provide in-home care to our clients.

We have a high interest in PCAs, but all qualified, quality candidate applications will be accepted and considered for hire.

Flexible Scheduling
Full-time or Part-time
Overtime Pay
Bonuses
Make a real difference in people’s lives

Job requirements for PCAs and Companion Caregivers

Drug test, background check, and clean driving required are essential!

Employee Application

Home Sweet Home Care Inc. • 346 Main Street •Smithfield, VA 23430 (757) 356-0342 office (757) 356-0344 fax Please fill out the form below if you are interested in employment at Home Sweet Home Care. We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status. YOU MAY BE DRUG TESTED TO DETERMINE EMPLOYMENT ELIGIBILITY.

Today's Date*
MM slash DD slash YYYY
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone
Mobile Phone
I am applying for a position as a
How did you hear about Home Sweet Home Care Inc.?
Emergency Contacts (please list two)
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Relationship
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Relationship
Transportation
Do you have dependable transportation?
- Yes
- No
Is your vehicle insured?
- Yes
- No
Vehicle Year
Vehicle Make
Vehicle Model
Enviromental Concerns
Some of our clients have dogs, cats or other pets, or client may smoke. Please check any item below which you cannot or prefer not to tolerate.
I prefer (or cannot) work around
- Smoking
- Cat
- Dog
- Bird
Other environmental concerns you have or comments
Education
High School
City/State
Did you Graduate?
- Yes
- No
College
City/State
Did you Graduate?
- Yes
- No
Other
City/State
Dates
Degrees/Certificates
Special Skills or courses
Experience
Discuss any training or experience you have working with the elderly
What would you like most about working with the elderly?
What would you like least about working with the elderly?
Many of our clients need assistance with everyday tasks. Please list some tasks you think you would be assisting the elderly with and activities that would be expected of you as a caregiver:
Employment History
(please list your work history starting with the most recent employment first). List a Minimum of 5 Years of Work History below.
May we contact your current employer?
- Yes
- No
Company Name
Store/Chain No.
Date
I began working for this employer on
MM slash DD slash YYYY
Date
I stopped working for this employer on
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Job Title
Reason you left position
Describe your duties during employement
Supervisor's Name
Phone (###) ###-####
Company Name
Store/Chain No.
Date
I began working for this employer on
MM slash DD slash YYYY
Date
I stopped working for this employer on
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Job Title
Reason you left position
Describe your duties during employement
Supervisor's Name
Phone (###) ###-####
Company Name
Store/Chain No.
Date
I began working for this employer on
MM slash DD slash YYYY
Date
I stopped working for this employer on
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Job Title
Reason you left position
Describe your duties during employement
Supervisor's Name
Phone (###) ###-####
Company Name
Store/Chain No.
Date
I began working for this employer on
MM slash DD slash YYYY
Date
I stopped working for this employer on
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Job Title
Reason you left position
Describe your duties during employement
Supervisor's Name
Phone (###) ###-####
Availability
(please indicate the days and times you are available for work)
I am available to work on these days
please check all that apply
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
I am available to work during these times
please check all that apply
- Mornings
- Afternoons
- Eveings
- Overnight
Certification and Release
I certify that I have read and understand the application and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment and that company policy requires that I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. PLEASE TYPE YOUR NAME BELOW TO CERTIFY THAT YOU HAVE READ THE CERTIFICATION AND RELEASE PARAGRAPH AND THAT YOU AGREE TO THE TERMS AS SHOWN ABOVE:
Today's Date
MM slash DD slash YYYY
Caregiver Positions
If I am applying for a CAREGIVER position, I understand that Home Sweet Home Care Inc. attempts to assign caregivers to clients as close to the caregiver’s residence as possible, but that clients exist in Isle of Wight, Smithfield, Suffolk, Portsmouth, Chesapeake, Newport News, Hampton, Poquoson and York County and that I may be asked to provide care to clients in those areas, and any other areas that Home Sweet Home Care Inc. may expand to serve in the future. I further understand that this position requires that I may have to work weekends and evenings, and that both hours and work schedules vary so that no firm number of hours or schedule is guaranteed or implied to be provided to me. I UNDERSTAND AND ACCEPT THAT PART OF HOLDING A CAREGIVER POSITION IS THAT WORK SCHEDULES AND LOCATIONS CAN VARY AS DESCRIBED ABOVE.
- Agree
- Disagree
Date
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

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Now Hiring Live In & Hourly PCAs & Companions.

Employee Application

Emergency Contacts (please list two)

Transportation

Enviromental Concerns

Education

Experience

Employment History

Availability

Certification and Release

Caregiver Positions