Application: Care Givers

CV
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Phone number*
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Cover letter
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Please note: Any paperwork not completed with your full legal name will need to be resubmitted. If the name you have entered above is different than your legal name on your social security card, please update above.

Are you authorized to work in the U.S.?*

You must be authorized to work in the U.S. for employment.

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You must be at least 18 years of age for employment.

Have you ever worked for Tridev Health Care? If yes, indicate your supervisor/role in the comments.*
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Have you ever had, or do you currently have a SpokeChoice account? (e.g. guardian, provider account)*
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Are you related to anyone currently working at Tridev Health Care? If yes, provide the person's name in the comments.*
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Do you have a current AZ Level 1 Fingerprint Clearance card?*

Certifications are not required to apply for this position. Tridev Health Care can assist in obtaining certifications prior to being hired.

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I understand Tridev Health Care conducts background checks with the following entities: AZ Department of Economic Security (AZDES), Department of Child Safety (DCS), Adult Protective Services (APS), Central Registry, System for Award Management (SAM), and the Office of Inspector General (OIG) for consideration of this position to work with children and/or adults.*
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Do you currently hold an RBT Certificate?*
If you are an RBT, please upload your RBT Certificate.
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Highest Level of Education Completed*
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This may include providing care to your family members or friends. Three months experience in caregiving is required for employment.

This may include time spent providing care to your family members or friends.

This may include time spent providing care to your family members or friends.


Reference 1

Must submit either a phone number, email address or both for your reference.

Must submit either a phone number, email address or both for your reference.

i.e. friend, co-worker, former supervisor, etc. Please note: Reference cannot be relatives or live in the same household as applicant

Reference 1 - Is this person related or living with you?*

References cannot be related to or living with you

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Reference 1 - Type of Reference*

A professional reference can include anyone who has observed you in a professional capacity including but not limited to a past or present supervisor, teacher, clergy, volunteer work, a colleague or mentor who is able to speak to your work ethic and character.

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Reference 2

Must submit either a phone number, email address or both for your reference.

Must submit either a phone number, email address or both for your reference.

i.e. friend, co-worker, former supervisor, etc. Please note: Reference cannot be relatives or live in the same household as applicant

Reference 2 - Is this person related or living with you?*

References cannot be related to or living with you

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Reference 2 - Type of Reference*

A professional reference can include anyone who has observed you in a professional capacity including but not limited to a past or present supervisor, teacher, clergy, volunteer work, a colleague or mentor who is able to speak to your work ethic and character.

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Reference 3

Must submit either a phone number, email address or both for your reference.

Must submit either a phone number, email address or both for your reference.

i.e. friend, co-worker, former supervisor, etc. Please note: Reference cannot be relatives or live in the same household as applicant

Reference 3 - Is this person related or living with you?*

References cannot be related to or living with you

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Reference 3 - Type of Reference*

A professional reference can include anyone who has observed you in a professional capacity including but not limited to a past or present supervisor, teacher, clergy, volunteer work, a colleague or mentor who is able to speak to your work ethic and character.

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U.S. Equal Opportunity Employment Information (Completion is voluntary)

Individuals seeking employment at our company are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.

Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

Veteran Status

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Voluntary Self-Identification of Disability (Form CC-305, OMB Control Number 1250-0005)

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability.

Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years.

How do you know if you have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Autism
  • Cancer
  • Diabetes
  • Epilepsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Cerebral palsy
  • Multiple sclerosis (MS)
  • Major depression
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Intellectual disability
  • Missing limbs or partially missing limbs
  • Impairments requiring the use of a wheelchair

Text message consent*

Tick Yes or No to indicate your agreement to receive text message updates from Tridev Health Care regarding your job application. Frequency may vary. Message and data rates may apply. Reply HELP for assistance. Reply STOP to opt out of future messaging.

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Equal Employment Opportunity
Tridev Health Care is an equal employment opportunity employer and does not discriminate against any person because of race, color, creed, religion, sex, national origin, disability, age, sexual orientation, genetic information or any other characteristic protected by law (refer to as "protected status"). This non-discrimination policy extends to all terms, conditions and privileges of employment as well as the use of all company facilities, participation in all company sponsored activities and all employment actions such as promotions, compensation, benefits and separation of employment.