Employee Application Form
Professional Employee Application Form template for Adult Family Homes. Includes editable Word (.docx) and printable PDF formats.
[YOUR ADULT FAMILY HOME NAME HERE]
Employee Application Form
TEMPLATE • Inspection-Ready AFH Standard
1. Applicant Contact & License Details
This agreement is entered into on this _____ day of ____________, 20___, between [ADULT FAMILY HOME NAME] (Provider) and [RESIDENT / POA NAME].
2. Employment History & References
FINANCIAL TERMSBase Rate & Payment Schedule: Resident agrees to pay Provider a monthly base fee of $______ payable in advance on the first (1st) day of each calendar month.
3. Background Disclosure & Certification
Provider Signature / Date
Resident / POA Signature / Date
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Document Section Breakdown (3 Sections)
Applicant Contact & License Details
Personal info, CNA/HCA license numbers, expiration dates, and work eligibility.
Employment History & References
Past 3 healthcare employers, supervisor contacts, and permission to call.
Background Disclosure & Certification
Criminal history disclosure, certification of truthfulness, and signature.
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