Kindness is a
language
which the deaf
can hear and
the blind can
read.


- Mark Twain   
         
"A Great Place to Live!"
Employment Application
Online Application >
* Required Field
Name*:
Address:*
Home Phone*:
Alt Phone:
Position Applying For*:
BCH Number/Location
Applying For*:
Salary Desired:
Referred By:
Date Available*:
High School (Name,
City, State):
Business or
Technical School:
College (Include
dates attended):
Graduate School
(Include dates attended):
References and
contact info:
Previous
Employer 1:
Address:
Position:
Contact:
Contact Phone:
Dates Worked:
Reson for
Leaving:
Previous
Employer 2:
Address:
Position:
Contact:
Contact Phone:
Dates Worked:
Reason for
Leaving:
Emergency Contact:
Contact Phone:
Date of Birth*:
Current Licenses
(CNA, LVA), if any:
Yes
No
Do you have previous experience or
association with people with disabilities?:
If yes, exlplain:
Yes
No
Do you have any physical or mental or medical
conditions that may limit your ability to perform the job?:
If yes, explain:
What means of transportation
do you have to get to work*?
Do you have a valid California
Driver's License?
Yes
No
Do you speak and understand
written English?
Yes
No
Spanish?
Yes
No
Have you ever been convicted of an
offense other than a minor traffic violation?
Yes
No
Yes
No
Have you ever been arrested for a sexual offense?
If yes, exlplain:
If employment is offered, can you submit
verification of your legal right to work in the USA?
Yes
No
Please enter any additional information you would like to supply:
I understand that falsification or omission of pertinent information on this
application or failure to pass State, Federal or company mandated
screening procedures may result in termination.  I agree to allow Bailey
Care Homes to check any statements made on this application and verify
any work experience.
Bailey Care Homes requires that all new employees submit their social
security number and undergo a physician examination and fingerprint
clearance as part of the screening process for all new employees.  Please
click the "Submit Application" button at the bottom of the application to
send the application to Bailey Care Homes, Inc.
Bailey Care Homes, Inc.