Apply for Service Coordinator

Become a Care Professional >> Service Coordinator >> Apply

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 3331 Street Rd, Building 2, Suite 405. 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 215-943-7700.

Summary
Title:	Service Coordinator
ID:	1080
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Opt-In Confirmation
	By submitting this application, I consent to receive SMS updates from Home Instead at 8556520807 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
Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

	- or Upload from:


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:

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. Additional testing for the presence of illegal drugs in your body is required prior to employment.

PERSONAL INFORMATION

Other Names Previously Used:

	Last Name	First Name	Middle Name
1.
2.

Emergency Contacts:

	Name	Phone	Relationship
1.
2.

* Have you ever submitted an application here before?

Yes No

If yes, when?

* Have you ever been employed here before?

Yes No

If yes, when?

* 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

How did you hear about our Home Instead franchise office?

Why are you interested in employment with Home Instead?

AVAILABILITY

* What type of employment are you seeking(check all that apply)?

Full time employment

Part time employment

On-call

* What date are you available to begin work?

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

* Extracurricular activities:

* Honors/Awards:

* Memberships in professional or job relevant organizations:

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

Third 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:

* What other qualifications, abilities and strong points will help you succeed in this position?

* What are your weak points?

* What are your career objectives?

BACKGROUND

As a condition of employment, all employees must be "Bondable".

List states and counties of residence for the past seven (7) years:

County:

State:

County:

State:

County:

State:

County:

State:

* Have you had any moving traffic violations?

Yes No

If yes, please describe:

* Have you been convicted of a felony or misdemeanor in the past seven (7) years?

Yes No

If Yes, please describe below:
(Conviction will not necessarily disqualify applicant from employment. The recency, severity, and pertinence of the conviction to the job will all be considered.)

Incident	City/State	Result

REFERENCES (Do not include relatives)

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

Professional References

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

Personal References

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

CERTIFICATION AND RELEASE

I certify that I have read and understand the applicant note on page one of this form 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 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 authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT. I ALSO UNDERSTAND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN MYSELF AND Associated Services LLC. IS TERMINABLE AT-WILL, SO THAT BOTH THE COMPANY AND I REMAIN FREE TO CHOOSE TO END OUR WORK RELATIONSHIP AT ANY TIME FOR ANY OR NO REASON. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING.

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

* Signature (type full name):
* Date:

Field Marketing Representative Pre Screen

Please answer all questions below.

* Do you have experience working for a home care agency?

	Yes
	No

* Do you have at least 1 year experience in sales or marketing?

	Yes
	No

* Do you have at least 1 year experience in client care or case management?

	Yes
	No

* Are you prepared to be "On Call" and work after office hours when needed?

	Yes
	No

What experience do you have working with computers and software?

Describe what experience you have in marketing and building relationships with referral sources, if any.

Describe what experience you have in client care or case management, if any.

Why do you want to make this change in employment at this time?

What are you expecting to get out this position that you were not getting in your previous position?

Provide an example of how you helped someone resolve their problem or issue recently?

What are your pay rate expectations?

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