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Job Application

Fill out the form below to apply as a CNA, HHA, or NEMT Driver with HomeTrust Staffing.

Position Applying For

Position applying for*

Personal Information

Full name*

Phone number*

Email address*

Home address*

City*

State

ZIP code*

Are you legally authorized to work in the United States?

YesNo

Are you at least 18 years old?

YesNo

Availability

Available start date

Schedule type (select all that apply)

Full-timePart-timePer diemWeekdaysWeekendsOvernightLive-inOn-call

Preferred shift

Counties or areas available to work in Florida

License and Certification

Are you applying as a CNA?

YesNo

Are you applying as an HHA?

YesNo

Do you have CPR / First Aid Certification?

YesNo

NEMT Driver Information

Are you applying as a NEMT Driver?

YesNo

Experience

Years of experience

Services provided before (select all that apply)

Personal careBathing / groomingMeal preparationMedication remindersDementia / Alzheimer's careCompanionshipLight housekeepingFacility staffingHospital discharge supportWheelchair transportationAmbulatory transportationStretcher transportationOther

Tell us about your previous experience

Employment History

Most recent employer

Job title

Start date

End date

Reason for leaving

May we contact this employer?

YesNo

Background and Screening

Are you willing to complete a background check?

YesNo

Are you willing to complete drug screening if required?

YesNo

Have you ever been convicted of a crime?

YesNo

Emergency Contact

Emergency contact name

Relationship

Emergency contact phone number

Document Upload

Resume

Click to upload

PDF, JPG, or PNG

Uploaded file

Driver's license

Click to upload

PDF, JPG, or PNG

Uploaded file

Auto insurance

Click to upload

PDF, JPG, or PNG

Uploaded file

Vehicle registration

Click to upload

PDF, JPG, or PNG

Uploaded file

Work authorization document

Click to upload

PDF, JPG, or PNG

Uploaded file

Other supporting documents

Click to upload (multiple allowed)

PDF, JPG, or PNG

Agreement

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification from employment or termination if hired.I authorize HomeTrust Staffing to verify my employment history, credentials, licenses, certifications, driving record, and background information as required for the position I am applying for.

Electronic signature*

Date*

Florida's trusted healthcare staffing agency — connecting families, seniors, and facilities with certified caregivers.

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+1 (320) 436-9234
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805 S Kirkman Rd, Ste 207
Orlando, FL 34761

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