CHHA Application

Follow us:
Way to Stay Homecare | 15070 Chandler Rd. Omaha, Ne 68138 | (402) 557-0639

Online: waytostayhome.com

Caregiver & Home Health Aide

Online Application Form

Way to Stay Homecare, LLC is a locally owned, non-medical, home health care company based out of Omaha, Nebraska.

We are currently seeking quality caregivers and home health aides for part-time, full-time, and PRN, to join our growing team!

Name: *

First Name Last Name
Birth Date

Month Day Year
Phone Number: *

- Area Code Phone Number
E-mail Address: *

Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How were you referred to us? *

Google Location Employee Indeed Facebook Twitter LinkedIn Instagram Craigslist MyCNAJobs Posters/Flyers Mailings
If Employee Referral was selected, what is the name of the employee who referred you?

What is your availability? *

	MON	TUES	WEDS	THURS	FRI	SAT	SUN
Day Shifts (6A-3P)
Evening Shifts (3P-10P)
Overnights (9P-9A)
12-Hour Shifts
PRN "on-call"
ALL

You may clarify your availability here, if needed:
When could you start working? *

- Month - Day Year
Date
Are you comfortable working with clients that own pets, including, but not limited to, cats & dogs? *

Yes No Unsure
Are you able to lift at least 25 pounds? *

Yes No Unsure
Do you have a phone with data & internet access? *

Yes No Unsure
Would you be comfortable working in a facility? *

Yes, I am able to work both In-Home & Facilities. No, I am better suited for In-Home care. Maybe, I am unsure at this time.
Job Skills & Training
Please select any certifications you currently hold: *

C.M.A. (Certified Med Aide) C.N.A. (Certified Nurse Aide) R.N. (Registered Nurse) CPR I do not hold any licenses or certifications at this time.
If you know your license and/or certification numbers, you may enter them here:
You can find your license number(s) here: https://www.nebraska.gov/LISSearch/search.cgi
Describe your skills: *
Tell us a little bit about your work history:
You may also copy/paste your resume here:
Are you legally able to work in the United States? *

Yes No
Have you been charged with theft, assault, fraud, a sexual violation, or a drug violation within the last 10 years?

Yes No
If you answered Yes to the previous question, you may elaborate here:
References

Please list two (2) references that are familiar with your work life.
Reference 1
Name: *

First Name Last Name
Phone Number *

- Area Code Phone Number
Years Known: *
Relationship: *
Reference 2
Name: *

First Name Last Name
Phone Number *

- Area Code Phone Number
Years Known: *
Relationship: *
What to expect after your application has been submitted:

Once submitted, your application will be reviewed and evaluated by our Administrator | HR representative. You should receive an email in regards to your application fairly quickly, anywhere from a few hours to a week. This email will let you know if we would like to meet with you for an in-person interview, and if so, we will request some days and times you may be able to come in to see us. During this interview, be prepared to walk through your work history, skills, job expectations, and overall career goals. Please bring your driver's license or state ID with you to your interview, as a copy may be requested. It is not necessary for you to bring your social security card with you at this time, but you may do so if you wish.
Share this form:
Should be Empty: