Careers Sitters & More | Job Application | CAN CPR

Job Application

121A Stonebridge Blvd.
Jackson, TN 38305

Sitters and More of West TN is an equal opportunity employer.

Last Name*

First Name*

Middle Name

Email

Mailing Address*

Street Address*

City*

State*

Zip*

How long at this address?*

Home Phone

Cell Phone

Other Phone

Emergency Contact*

Phone*

Relationship*

Position Applying For*

Earnings Expected*

What hours/shifts/days are you available to work?*

Are you a CNA?

Yes
No

Current C.P.R.?

Yes
No

Current First Aid?

Yes
No

Copy of cards will be required.

Have you been convicted of a crime?*

Yes
No

If yes, indicate offense, date and explain. (Conviction does not necessarily mean disqualification.)

Are you 18 or older?*

Yes
No

Drivers License Number*

Expiration Date*

Do you smoke?*

Yes
No

I understand that Sitters and More of West TN is a smoke-free workplace.*

Enter the school name, year completed, and diploma/degree for each level of education you have completed below.

High School

College

Vocational

Graduate/Professional

Provide 3 references below. Include name, phone number, city, state and how long you have known the person for each.

Reference 1

Reference 2

Reference 3

Please list at least 5 years of employment history starting with your most recent employment. Include any job-related military service assignments.

May we contact your current employer?

Yes
No

Employer 1

Employment Start Date

Employment End Date

Duties

Address

City

State

Zip

Supervisor

Phone

Starting Hourly Rate

Final Hourly Rate

Reason for leaving?

Eligible for Rehire?

Yes
No

Employer 2

Employment Start Date

Employment End Date

Duties

Address

City

State

Zip

Supervisor

Phone

Starting Hourly Rate

Final Hourly Rate

Reason for Leaving

Eligible for Rehire?

Yes
No

Employer 3

Employment Start Date

Employment End Date

Duties

Address

City

State

Zip

Supervisor

Phone

Starting Hourly Rate

Final Hourly Rate

Reason for Leaving

Eligible for Rehire?

Yes
No