Apply for Social Worker

Hello and thank you for your interest in Home Instead. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 4140 Sheridan Drive, Suite 5, Williamsville, NY 14221. Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at (716) 630-0657.

Summary
Title:	Social Worker
ID:	6567
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Home Phone:
Cell Phone :
Work Number:
* Email:
Opt-In Confirmation
	By submitting this application, I consent to receive SMS updates from Home Instead at 8559391008 regarding my employment application. My information will not be shared or used for any other purposes. This application is powered by ApplicantStack on behalf of Home Instead. SMS messages will only be sent by Home Instead and are used exclusively for hiring-related communications when you have subscribed to receive SMS communications.
Attachments
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Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Additional Information

* How did you hear about Home Instead?

If applicable, please specify:

Applicant Note & Certification

APPLICANT NOTE

HJBW Enterprises, LLC is an independently owned and operated Home Instead® franchise 4140 Sheridan Drive, Suite 5, Williamsville, NY 14221 (716) 630-0657.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

US Key Player Application for Employment

APPLICANT NOTE

If you are considered for a position, we may contact your references and would ask that you notify them in advance. Please do not list relatives or family/relations.

INSTRUCTIONS: If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

Please read "Applicant Note” below.
Complete all pages off this application.
Print clearly. Incomplete or illegible applications may not be accepted.
If more space is needed to complete any question, use comments section on the back.
Application will be valid for 60 days.

Applicant Note: This application form is intended for use in evaluating your qualifications for employment with us , an independently owned and operated Home Instead franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

PERSONAL INFORMATION

* Are you 21 years of age or older?

Yes No

* Are you able to lift 25 pounds?

Yes No

* Do you have reliable transportation?

Yes No

* Have you ever submitted an application here before?

Yes No

* You have been given a copy of the job description for the position for which you have applied. Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?

Yes No

EDUCATION

Please check the highest grade level completed:

	Name	City, State	# Yrs Attended	Graduate?
High School	*	*	*	* Yes No
Vocational/Technical				Yes No
College/University				Yes No

PROFESSIONAL EXPERIENCE

Most Recent Employer

Company Name	City and State	Company Phone

Dates Employed	Job Title	Supervisor Name
From: To:
Duties

What did you like most about this position?	Reason for Leaving

Second Most Recent Employer

Company Name	City and State	Company Phone

Dates Employed	Job Title	Supervisor Name
From: To:
Duties

What did you like most about this position?	Reason for Leaving

* Desired Compensation per___?

OTHER

* Describe any work history or training you've completed related to senior care and service:

* Describe any extracurricular activities/honors/awards.

* List any memberships in professional or job relevant organizations:

REFERENCES (Do not include relatives)

Please complete all four references (two professional/two personal). Your application will not be considered unless two references are provided. Since we will contact these references, please notify them in advance. .

Professional References

Full Name	Phone Number	Email	Relationship	Number of Years Known
*	*	*	*	*
*	*	*	*	*

Personal References

Full Name	Phone Number	Email	Relationship	Number of Years Known
*	*	*	*	*
*	*	*	*	*

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

New York Correction Law Article 23-A

NEW YORK CORRECTION LAW
ARTICLE 23-A
LICENSURE AND EMPLOYMENT OF PERSONS PREVIOUSLY
CONVICTED OF ONE OR MORE CRIMINAL OFFENSES

Section 750. Definitions.
751. Applicability.
752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited.
753. Factors to be considered concerning a previous criminal conviction; presumption.
754. Written statement upon denial of license or employment.
755. Enforcement.

§750. Definitions. For the purposes of this article, the following terms shall have the following meanings:

(1) "Public agency" means the state or any local subdivision thereof, or any state or local department, agency, board or commission.
(2) "Private employer" means any person, company, corporation, labor organization or association which employs ten or more persons.
(3) "Direct relationship" means that the nature of criminal conduct for which the person was convicted has a direct bearing on his fitness or ability to perform one or more of the duties or responsibilities necessarily related to the license, opportunity, or job in question.
(4) "License" means any certificate, license, permit or grant of permission required by the laws of this state, its political subdivisions or instrumentalities as a condition for the lawful practice of any occupation, employment, trade, vocation, business, or profession. Provided, however, that "license" shall not, for the purposes of this article, include any license or permit to own, possess, carry, or fire any explosive, pistol, handgun, rifle, shotgun, or other firearm.
(5) "Employment" means any occupation, vocation or employment, or any form of vocational or educational training. Provided, however, that "employment" shall not, for the purposes of this article, include membership in any law enforcement agency.

§751. Applicability. The provisions of this article shall apply to any application by any person for a license or employment at any public or private employer, who has previously been convicted of one or more criminal offenses in this state or in any other jurisdiction, and to any license or employment held by any person whose conviction of one or more criminal offenses in this state or in any other jurisdiction preceded such employment or granting of a license, except where a mandatory forfeiture, disability or bar to employment is imposed by law, and has not been removed by an executive pardon, certificate of relief from disabilities or certificate of good conduct. Nothing in this article shall be construed to affect any right an employer may have with respect to an intentional misrepresentation in connection with an application for employment made by a prospective employee or previously made by a current employee.

§752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. No application for any license or employment, and no employment or license held by an individual, to which the provisions of this article are applicable, shall be denied or acted upon adversely by reason of the individual's having been previously convicted of one or more criminal offenses, or by reason of a finding of lack of "good moral character" when such finding is based upon the fact that the individual has previously been convicted of one or more criminal offenses, unless:

(1) There is a direct relationship between one or more of the previous criminal offenses and the specific license or employment sought or held by the individual; or
(2) the issuance or continuation of the license or the granting or continuation of the employment would involve an unreasonable risk to property or to the safety or welfare of specific individuals or the general public.

§753. Factors to be considered concerning a previous criminal conviction; presumption.

1. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall consider the following factors:

(a) The public policy of this state, as expressed in this act, to encourage the licensure and employment of persons previously convicted of one or more criminal offenses.
(b) The specific duties and responsibilities necessarily related to the license or employment sought or held by the person.
(c) The bearing, if any, the criminal offense or offenses for which the person was previously convicted will have on his fitness or ability to perform one or more such duties or responsibilities.
(d) The time which has elapsed since the occurrence of the criminal offense or offenses.
(e) The age of the person at the time of occurrence of the criminal offense or offenses.
(f) The seriousness of the offense or offenses.
(g) Any information produced by the person, or produced on his behalf, in regard to his rehabilitation and good conduct.
(h) The legitimate interest of the public agency or private employer in protecting property, and the safety and welfare of specific individuals or the general public.

2. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall also give consideration to a certificate of relief from disabilities or a certificate of good conduct issued to the applicant, which certificate shall create a presumption of rehabilitation in regard to the offense or offenses specified therein.

§754. Written statement upon denial of license or employment. At the request of any person previously convicted of one or more criminal offenses who has been denied a license or employment, a public agency or private employer shall provide, within thirty days of a request, a written statement setting forth the reasons for such denial.

§755. Enforcement.

1. In relation to actions by public agencies, the provisions of this article shall be enforceable by a proceeding brought pursuant to article seventy-eight of the civil practice law and rules.
2. In relation to actions by private employers, the provisions of this article shall be enforceable by the division of human rights pursuant to the powers and procedures set forth in article fifteen of the executive law, and, concurrently, by the New York city commission on human rights.

* Signature (type full name):
* Date:

Release & Authorization for Criminal Background Check

Background Check Notice and Disclosure

HJBW Enterprises, LLC, d/b/a an independently owned and operated Home Instead franchise ("the Company"), is providing you with notice that it may order a consumer report may be obtained for employment purposes as part of the pre-employment background investigation and at any time during your employment.

The Company may order an “investigative consumer report.” Such reports typically include information from personal interviews, most commonly from an applicant’s prior employers and references. Should an investigative consumer report be requested, you will have the right to request a complete and accurate disclosure of the nature and scope of the investigation requested and a written summary of your rights under the Fair Credit Reporting Act.

The background report may contain information concerning your character, general reputation, personal characteristics, mode of living and criminal history. Information may be obtained from private and public record sources, and for investigative consumer reports, from personal interviews as noted above.

Authorization for Procurement of Consumer Report

Pursuant to the federal Fair Credit Reporting Act, I authorize HJBW Enterprises, LLC, d/b/a an independently owned and operated Home Instead franchise ("the Company and its designated agents and representatives to order a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee.

I understand that, to the fullest extend allowed by law, information contained in my employment application or otherwise disclosed to the Company by me in the hiring process or during my employment may be utilized for the purpose of obtaining consumer reports.
I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; professional credentials and licenses and any other public records. I authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have.
I authorize and request any present or former employer, school, law enforcement and all other federal, state and local agencies; federal, state and local courts, financial institution or other persons having personal knowledge of me to furnish the Company or its designated agents with any and all information in their possession regarding me in connection with an application of employment.
I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s rights will be provided to me.
If hired, or if already employed, this authorization shall remain on file and shall serve as an ongoing authorization for the Company to obtain consumer reports, at any time during my employment, for employment purposes. Further, if hired, or already employed, my signature below authorizes the Company to supply my employment history with the Company to a consumer reporting agency.
My signature below signifies my receipt and understanding of the "Background Check Notice and Disclosure" and authorizes the Company to obtain consumer reports regarding me.

* First Name

* Last Name

* Middle Name

Maiden/Previous Names

* Home Address

* City

* State

* Zip Code

* Social Security Number

* Date of Birth

* Driver's License Number

* Issuing State

* Signature (type name)

* Date

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

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