Home Sweet Home on the Hudson Logo
SENIOR COMMUNITY • ADULT CARE FACILITY • ASSISTED LIVING PROGRAM




EMPLOYMENT OPPORTUNITIES

If you wish to apply for a job at Home Sweet Home on the Hudson,
you may download the PDF application by clicking the link below.
You can complete it online using
Adobe Acrobat software
or print it out to complete it by hand.
If you complete it online, you can provide access to your form
via Adobe Acrobat's distribution options;
or you can attach your PDF application to an email and send to:
employment@homesweethomeonthehudson.com.

If you print it out and complete it on paper.
you can
fax it to 518-943-5033;
or mail it in an envelope addressed to:

Home Sweet Home on the Hudson, Inc.
Attn: Employment Opportunities
38 Prospect Avenue
Catskill, NY 12414

Tel: 518-943-5701
Fax: 518-943-5033


DOWNLOAD EMPLOYMENT APPLICATION AS PDF

Or feel free to complete the Secure Employment Application Form below
and return to us on our secure server by clicking the "send" button at the bottom of the form.

About Our Secure Server and Encrypted Form Data
Your information will be encrypted so sensitive personal information will be protected.
Note that the browser address of this page begins with https, the "s" standing for "secure."
When you click the "send" button, your browser's security system
will warn you that although this page is encrypted, you will be transmitting your information over
an unencrypted connection and your data "could easily be read by a third party."
However, encrypting your data, which means it is rendered in indecipherable digital code,
ensures that your information cannot be read even if it is intercepted.
If you are uncomfortable with this method, which is used by all banks and e-commerce sites
on the Internet, you can download the PDF form, fill it out by hand and
hope no one accesses your data when you fax or mail it.

All fields are required.


SECURE ONLINE EMPLOYMENT APPLICATION

Date

Your Full Name

Your home phone number

Your cell phone number

Your email address

Your Social Security Number


Your Present Address:
Street

City

State

Zip

Your Permanent Address:
Street

City

State

Zip


Are You 18 Years of Age or Older?

Are You a U.S. Citizen?

If no, please indicate type of Visa

Have You Ever Been Seriously Injured?

If yes, please provide details

Have You Ever Been Convicted of a Felony or Misdemeanor?

If yes, please provide details


Employment Desired:
Position Desired

Shift Preferred

Date You Can Start

Salary Desired


Education:
Name of High School Attended

Location of High School Attended

Did You Graduate?

High School Subjects Studied


Name of College Attended

Location of College Attended

Did You Graduate?

College Subjects Studied


Name of Other School Attended

Location of Other School Attended

Did You Graduate?

Other School Subjects Studied


Former Employers
Former Employer #1: Name

Former Employer #1: Address

Starting Date: Month/Year

Leaving Date: Month/Year

Job Title

May We Contact Your Supervisor?

Name and Title of Supervisor

Phone Number of Supervisor

Description of Work

Reason for Leaving


Former Employer #2: Name

Former Employer #2: Address

Starting Date: Month/Year

Leaving Date: Month/Year

Job Title

May We Contact Your Supervisor?

Name and Title of Supervisor

Phone Number of Supervisor

Description of Work

Reason for Leaving


Former Employer #3: Name

Former Employer #3: Address

Starting Date: Month/Year

Leaving Date: Month/Year

Job Title

May We Contact Your Supervisor?

Name and Title of Supervisor

Phone Number of Supervisor

Description of Work

Reason for Leaving


Former Employer #4: Name

Former Employer #4: Address

Starting Date: Month/Year

Leaving Date: Month/Year

Job Title

May We Contact Your Supervisor?

Name and Title of Supervisor

Phone Number of Supervisor

Description of Work

Reason for Leaving


FOR HOME HEALTH AIDE OR PERSONAL CARE AIDE APPLICANTS ONLY:


I understand that Home Sweet Home, Inc. is mandated to
update the New York State Department of Health Home Care Registry.
I understand that the information given to the registry
is made available for public viewing.
(Any questions, please call the Department of Health at 1-877-877-1827.)

Your Name Below Certifies Your Acceptance of the Above Terms


AUTHORIZATION
By clicking the "send" button below,
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false
information, omissions, or misrepresentations are discovered, my application may be rejected and if I am employed, my
employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s
rules and regulations. I am aware that there is a probation period of 3 months upon hiring.
Your Name Below Certifies Your Submission of This Application

Please add any comments you have below:





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HOME
| SETTING | BENEFITS | ACTIVITIES | DIRECTIONS | CONTACT | EMPLOYMENT




Home Sweet Home on the Hudson, Inc.
38 Prospect Avenue
Catskill, NY 12414

Tel: 518-943-5701

Fax: 518-943-5033


info@HomeSweetHomeOnTheHudson.com
www.HomeSweetHomeOnTheHudson.com



Any questions related to Assisted Living may be directed to:
New York State Department of Health
Division of Long Term Care
Bureau of Certification and Finance
875 Central Avenue
Albany, NY 12206
(518) 408-1624

© 2012 HomeSweetHomeontheHudson.com