Apply To Be A Care-Giver

Serenity Home Care — Job Application

Serenity Home Care

Job Application

Apply to join our team

We're glad you're considering Serenity Home Care. Please fill out the form below — it takes about 8–10 minutes. Fields marked * are required. When you submit, your email app will open with your application ready to send to our hiring team.

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Street Address

City

State

ZIP Code

Position Details

Position Applying For *

Earliest Start Date *

Valid driver's license & reliable transportation? *

Yes

At least 18 years old? *

Yes

Certifications held (e.g. CNA, HHA, CPR/First Aid — optional)

Availability

Tap all shifts you're available to work, for each day. At least one is required.

Work Experience

Employer Name

Job Title

Start Date

End Date

Job Responsibilities

Reason for Leaving

+ Add another employer

References

Please provide 3 professional references (not family members). *

Reference 1

First Name *

Last Name *

Relationship *

Phone Number *

Reference 2

First Name *

Last Name *

Relationship *

Phone Number *

Reference 3

First Name *

Last Name *

Relationship *

Phone Number *

Background & Eligibility

Ever convicted of a crime? *

Yes

Legally authorized to work in the U.S.? *

Yes

If yes, please explain (optional)

Willing to complete a background check & drug screening? *

Yes

How did you hear about us?

Certification & Signature

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false statements or omissions may disqualify me from employment or result in termination if discovered later. I authorize Serenity Home Care to verify the information provided and to contact references and previous employers.

I have read and agree to the statement above. *

Signature (type your full name) *

Date *

Submitted Applications

Visible to anyone with this link — for internal use.

✓

Almost done — one more step

Your email app should have opened with your application pre-filled, addressed to Info@serenity-care-agency.com — please press Send in that app to finish submitting. You should also receive a separate confirmation email from us shortly.

Apply To Be A Care-Giver

Serenity Home Care

Apply to join our team

Personal Information

Position Details

Availability

Work Experience

References

Background & Eligibility

Certification & Signature

Submitted Applications

Almost done — one more step

Serenity Care Agency

Info@serenity-care-agency.com

203-274-6957