How many years of caregiving experience do you have? :

Do you have a valid driver's license and car insurance? :

Are you willing to work around non-threatening animals? :

How many hours can you work weekly?

Are you available to work nights?

Are you available to work weekends?

Are you legally authorized to work in the US?

When are you available to start work?

Where did you hear about us?

Have you ever worked under a different name? If YES, what was it and what was the reason?

Do you have any relatives that work for the company?

In exchange for the consideration of my job application by Dalyan Care, LLC DBA Senior Helpers Houston (hereinafter called “Senior Helpers”), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Senior Helpers company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Senior Helpers, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President of the Senior Helpers. Both the undersigned and Senior Helpers may end the employment relationship at any time, without specified notice or reason. If employed, I understand that Senior Helpers may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I also understand that (1) Senior Helpers has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. I understand the following information: §93.3 Employment and Registry Information (a) Before a facility, agency, or individual employer hires an employee, the facility, the agency, the individual employer, or an FMSA on behalf of the individual employer must search the EMR and NAR to determine if the person applying for employment is listed as unemployable on either registry.(b) A facility, agency, or individual employer must not hire or continue to employ a person listed in the EMR or NAR as unemployable.(c) A facility, agency, or individual employer must, within five working days after hiring an employee, provide written information to the employee explaining: (1) that a person listed in the EMR is not employable by a facility, agency, or individual employer; and (2) that the EMR is governed by this chapter and THSC, Chapter 253. (d) A facility, agency, individual employer, or FMSA on behalf of an individual employer must search the EMR and NAR annually to determine if an employee is listed on either registry as unemployable.(e) A facility, agency, individual employer, or FMSA on behalf of an individual employer must maintain a copy of the results of the searches required by subsections (a) and (d) of this section in the books and records maintained by the entity that conducted the search. I understand that, in connection with the routine processing of your employment application, Senior Helpers may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, Senior Helpers will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I hereby release any and all prior employers or current employers from liability or claims arising out of the provision of information about my employment with such employer. I hereby waive any cause of action I might otherwise have against such employer arising out of the provision of information concerning my employment.