Application Form

Living at Home's Mission:

Living at Home supports the dignity and quality of life of seniors and people living with disabilities by providing non-medical personal care and other caregiver services in private homes, independent and assisted living centers, hospitals, nursing homes and other facilities. Living at Home is committed to respecting the integrity, wisdom, and uniqueness of each and every client.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.

Personal Information

Section 1 - General Information

Section 2 - Employment Verification

Section 3 - Education

Section 4 - Other Training: Certifications/Licenses

Section 5 - Current Employment

Section 6 - Employment History

Section 7 - Reference 1

Section 8 - Reference 2

Section 9 - Emergency Contact Information

I certify that the facts contained in this application are true and complete to the best of my knowledge. 

I understand that, if employed, falsified statements on this application will be grounds for dismissal. 

In consideration for my employment, I agree to conform to the rules and regulations of Nova Leap Health NH II d/b/a Living at Home. 

I acknowledge that rules may be changed, withdrawn, added or interpreted at any time, at Living at Home's sole option and without prior notice to me. 

I authorize Living at Home to investigate all statements contained within this application. I understand that if the information provided on this application cannot be satisfactorily verified by employment reference checks, my application could be considered incomplete. 

I authorize Living at Home to contact any and all personal and employment references I have provided. 

I give Living at Home permission to investigate any and all information concerning my previous employment history as well as any job-related information previous employers may have, personal or otherwise. I authorize any of the persons and organizations listed on this application to give Armistead any and all information concerning my previous employment, education, and qualifications for employment. 

I also authorize Living at Home to request and receive such information. I hereby release employers, schools, or individuals from all liability in responding to inquiries in connection to my application. I release Living at Home from all liability for any damage that may result from utilization of such information. 

I understand that filling out this application and participating in this interview does not constitute a job offer. 

I understand that due to the large number of applications Living at Home receives and the competitive nature of Living at Home's employment process, specific reasons for employment decisions will not be released.

I understand that Living at Home reserves the right to revise or alter policies at any time without notice.

By clicking "Submit Application", you agree to the above terms and conditions.