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Careers | Generations Home Care
Complete List of Services
Alzheimers, Dementia, Parkinsons Care
Medication Reminders & Safety
Personal Care & Hygiene
Physical Assistance & Homemaking
Places We Care
Respite Care for Family Caregivers
Special Care Situations
Generations’ Promise To You…
Average Cost of Care
The Veteran’s Aid and Attendance Pension
Medicare & Medicaid
Private and Long Term Care Insurance
Self Pay or Private Pay
Custom Care Plans
Family Learning Center
Making a Difference
Interactive Learning Sessions
How to Prevent Falls by Playing Bingo!!!
Reduce the Risk of Falling
Useful Links for Family Care
Top 10 Questions to Ask When Hiring a Home Care Agency
“Family Caregivers Lose $300,000 in Income Over Their Lifetime”
Arizona Home Care Blog
Step 1 of 11
State / Province / Region
Primary Phone Number
Resume and Experience
Drop files here or
Can you provide proof, if hired, of your identity and eligibility to work in the United States?
Are you at least 18 years old?
Date Available to Start:
Salary or Wage expected?
Please list any additional information you feel may be helpful to us in considering your application.
We are interested to know how you found us. Please tell us your source below:
Private Employment/Temp Agency
Internet - Job Website
Walked In Onsite
Work Preferences (Check all that you are interested in):
What shift schedule(s) are you looking for?
Have you checked all shifts you are willing to work?
Please indicate what days you are available to work:
What Professional License Certifications Do you Have?
Check all that apply:
DL - Drivers License
SSC - Social Security Card
CNA - Certified Nursing Assistant
HHA - Home Health Aide
LNA - Licensed Nursing Assistant
ALCG -Assisted Living Certified Caregiver (NCIA Board - 104 Hour Program)
DCW - Direct Care Worker (Home and Community Based Medicaid Program)
Arizona Level One Fingerprint Card
Current TB Test
Date Format: MM slash DD slash YYYY
If you are a CNA, LNA or HHA, your license must be in good standing. Do you have a valid professional license?
Certified Nursing Assistant
Licensed Practical Nurse
State Tested Nurses Aide
Nursing Home Administrator
Assisted Living Administrator
Certified Medication Technician
Certified Medication Aide
Certified Activities Director
Speech Language Pathology
Physical Therapist Assistant
Certified Public Accountant
Issuing College, Technical School, or Organization
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Do you have another professional license or certification?
If yes, what license or certification?
Has your license, registration, or certification ever been investigated, revoked, suspended, limited, or subject to discipline, by any board or governing authority?
If yes, please explain:
please select the highest education level you have completed:
Name of School
State / Province / Region
What was your GPA/Scale (i.e. 3.5/4.0)
Do you have a degree?
If so, what Degree? (AS, BS, etc.)
Field of Study
Work Experience and Skills
Please select the work experience or skills from the list you have.
Dementia / Alzheimer’s
Stroke / Cardiac
Assistance with Activities of Daily Living (ADL's)
Traumatic Brain Injury
Spinal Cord Injury
Children with Disabilities
Adults with Disabilities
Fall Prevention / Client Safety
Meal Planning / Preparation
Homemaking / Housekeeping
Direct Care Worker (DCW) - Medicaid
Community Healthcare Worker (CHW)
Caregiver for a Loved One
Previous Facility Types Worked
Please select the type of facilities you have worked in before.
Skilled Nursing Home
Private Duty (Private Home)
Live-In (Private Home)
Overnight Care (Private Home)
Have you ever been employed by Southland Home Health?
If yes, please list: Job Title, Start date, End Date and Reason for Leaving:
Have you ever applied at Generations Home Care?
If yes, what year?
Have any of your relatives ever worked for this company?
If yes, please provide the name:
Do any of your friends work here?
If yes, please provide the name:
Please list three references of a professional nature
Please identify your gender.
Please identify your ethnicity.
Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.)
If checked no, which of the following best describes your ethnicity?
Black or African American
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Two or more races - which DO NOT include Hispanic or Latino
This company is an Equal Opportunity/Affirmative Action employer and subject to certain reporting and affirmitve action requirements. The information required on this page is requested only so that we may meet our Equal Opportunity/Affirmative Action obligations. Your completion of this form is purely voluntary and will not, in any way, affect your consideration for employment. Any information you provide on this page will be stored separately from your job application.
Check here, if you do not wish to provide the information requested.
Criminal Convection History
I agree that I have not been convicted of a crime such as molestation, rape, battery, neglect, exploitation, felony theft, or any other substantially related crime to a dependent population.
I Don't Agree
- "Molest" means to annoy or to meddle with so as to trouble or harm; to make improper sexual advances.
- "Rape" means to have sexual intercourse with a person forcibly and with consent; any sexual, violent or outrageous assault.
- "Battery" means knowingly or intentionally touching another person in a rude or angry manner(i.e.m grabbing or shoving in a rude, angry manner; slapping or hitting; and knocking someone to the floor).
- "Neglect" means placing a dependent in a situation that may endanger his/her life or health (i.e., abandoning or cruelly confining a dependent or depriving a dependent of necessary support, including food, clothing, shelter or medical care.
- "Dependent" means a person of any age who is mentally or physically disabled who is under the care of another person.
- "Exploitation" means unauthorized use of an adult dependent or his/her resources for one's own profit or advantage, or for the profit or advantage of another.
- "Theft" means a criminal act in which property belonging to another is taken without that persons consent.
I fully understand that I must report all accidents to my immediate supervisor and to Southland Home Health and Hospice. I also understand that I must wear all required personal protective equipment (PPE). The penalty for not wearing PPE is disciplinary action, up to and including termination. In signing this application, I certify that I have read and fully understand the questions asked in this application and that all answers given by me are true, accurate, and complete. I also understand that the omission, concealment, or misrepresentation of any fact on this application or during any interview for employment may jeopardize my chances for employment and be cause for my immediate dismissal from employment. I give Southland Home Health and Hospice permission to use any information in this application to enable it and its agents to verify the information contained in this application 1 also authorize present and former employers, educational institutions I have attended, credit agencies, all references, and any other persons to answer all questions asked by Southland Home Health and Hospice with regard to any of the subjects covered by this application. I also understand that in connection with my application for employment or my employment, Southland Home Health and Hospice may conduct a criminal background investigation and that my employment may be contingent on the results of such investigation. I release Southland Home Health and Hospice, its agents, and affiliated entities, as well any person or situation that provides any information about me, from any and all liability whatsoever resulting from any such investigation or the disclosure or such information. In consideration of my employment and of my being considered for employment by Southland Home Health and Hospice, I agree to abide by all rules and regulations, which I understand are subject to change at any time for any reason without prior notice. I also understand that if employed, I will be an employee at will and employed for no definite period of time. I understand that either Southland Home Health and Hospice or I can terminate my employment at any time, with or without cause and with or without advance notice. I further understand that no communication, whether oral or written, by any representative or Southland Home Health and Hospice, has the authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing. I am willing to submit to submit to a physical examination, including the analysis for the detection of the use of unlawful drugs or substances in accordance with the applicable laws. If I receive an offer of employment I agree that my continued employment may be contingent on the results. I understand that Southland Home Health and Hospice is not involved in the day-to-day supervision or decision concerning patient care or dentistry. This remains with the Professional as part of the Professional's practice, The Professional fully indemnifies Southland Home Health and Hospice against any and all liability and responsibility associated with his or her professional duties. The Professional maintains his or her license as required by law, professional liability coverage and other responsibilities as found under state prime contract law.
I have read, understood and agree to the above statement and to the terms and conditions for the use of electronic signature.