INQUIRE ABOUT SERVICES
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Application for Employment

We offer equal employment opportunities to all qualified persons without regard to race, color, religion, age, marital or veterans' status, sex, disability, national origin, or any other legally protected status. Caring Services, Inc. is an Equal Opportunity Employer.

Are you at least 18 years of age?
Yes
No
Are you related to any current employees or clients of CSI?
Yes
No
Have you applied for a job with us before?
Yes
No
Have you ever worked for us before?
Yes
No
Have you ever been convicted of a criminal offense other than a minor traffic violation? Do not include any arrests that did not result in a conviction, or any convictions that have been expunged or sealed.
Yes
No

A conviction will not necessarily disqualify you from employment.

Disclosure will not necessarily disqualify you for employment. Each event will be evaluated on its own merits with respect to time, circumstances, seriousness and potential relation to the job.

Have you ever received alternative sentencing from a court instead of a conviction or a guilty please?
Yes
No

Disclosure will not necessarily disqualify you for employment. Each event will be evaluated on its own merits with

respect to time, circumstances, seriousness and potential relation to the job.

Disclosure will not necessarily disqualify you for employment. Each event will be evaluated on its own merits with respect to time, circumstances, seriousness and potential relation to the job.

Have you ever held a position of trust (handling money or confidential material)?
Yes
No
Have you ever been listed by a Federal Agency as debarred, proposed for debarment or suspension or otherwise excluded from Federal Medicare/Medicaid participation?
Yes
No

Education

Secondary School information

Completion Status:
High School Graduate (Diploma)
GED Certificate
Did not graduate/no GED
Other

Postsecondary Education

Did you graduate?
Yes
No
Did you graduate?
Yes
No
Did you graduate?
Yes
No

Employment History

Please fill out completely, even if attaching resume. Please describe all work experience beginning with the most recent.

Employer #1

Start Date
Month
Day
Year
End Date
Month
Day
Year

Employer #2

Start Date
Month
Day
Year
End Date
Month
Day
Year

Employer #3

Start Date
Month
Day
Year
End Date
Month
Day
Year

Applicant's Agreement and Certification

1. I certify that facts set forth in this Application for Employment are true and complete to the best of my knowledge and that I completed the application myself. I understand that any false statements, omissions or misrepresentations may result in denial of employment or my dismissal, after employment. I authorize Caring Services, Inc. to investigate

any of my responses as set forth in this application and release CSI from any liability.

2. I understand that employment at Caring Services, Inc. is "at-will'', which means that either I, or CSI, can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute or law. All employment is continued on that basis.

3. I understand that if a conditional offer of employment is made to me, it is conditioned upon my successful completion of a pre-employment drug test and criminal background check. I further understand CSI also performs medical examinations, post-accident, random, and for cause drug testing throughout the course of employment in accordance to state and federal law and that at any time during the course of employment I am subject to drug testing. I further understand that refusal of any drug test will be treated as a positive drug test and could result in termination of

employment.

4. I understand that if employed, policies or procedures, in whole or in part may be revised, at any time and that I have an obligation to remain informed and seek clarification to the best of my ability.

5. I understand that all property, personal or otherwise on CSI premises, is subject to search at any time, with or without notice.

6. I understand that this application will be active for the position I applied for only, after which time I have to reapply in accordance with established company procedures.

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ADDRESS

Trillium logo

PHONE

CARF logo

EMAIL

102 Chestnut Drive High Point, NC 27262

Phone: (336) 886-5594

Fax: (336) 886-4160

Office Hours: 8am - 5pm Monday - Friday

© 2026 Caring Services, Inc. 

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