Application Form

HAAS welcomes applicants to submit a resume and cover letter in addition to the completed and signed of this application form. HAAS will communicate interests to applicants within two weeks of receipt of application. Any applicant being considered for a PCA position must complete all necessary forms before starting assignment for employment.


Disclaimers: PCA positions are filled to meet the needs of our consumers; therefore, HAAS does not guarantee a set schedule or number of hours per week. All PCA’s remain an employee of HAAS, although they will be supervised and scheduled primarily by the consumers that they provide supports for. If a consumer discharges the employee, HAAS will make every reasonable effort to coordinate re-assignment with another consumer- PCAs are not considered “employed” in this transition period.


Employment Application




APPLICANT INFORMATION



PREVIOUS EMPLOYMENT

Have you ever been terminated from a job due to poor performance?

Please list below your employment history for the last 3 years accurately to the best of your knowledge:



  1. May we contact your supervisor?

    Dates worked for this employer:

    ______________________

  2. May we contact your supervisor?

    Dates worked for this employer:

    ______________________

  3. May we contact your supervisor?

    Dates worked for this employer:

    ______________________

Please check off any skills that you have experience with:

Please check off any skills that you do not want to perform


PCA Applicant Availability

My primary form of transportation is
I am interested in providing on-call coverage
Indicate shift(s) you are interested in for on-call

Please write in your earliest start and end times for each day:


Start time signifies the time you arrive at the consumer’s home.


Please be mindful of the time it will take you to commute when filling out this section.


I AM AVAILABLE TO START AT:









Background Checks

Please answer each of the following:

Are you able to provide proof that you are at least 18 years of age?
Do you have a valid MN Driver’s License or a current MN State ID?
Are you legally authorized to work in the U.S. and can provide verification?

Have you ever been accused of or charged with physical abuse, sexual abuse, neglect or exploitation of a vulnerable individual?

Have you ever been convicted of a felony?

Are you using or dependent on mood-altering chemicals, including alcohol?

HAAS accepts applications from all applicants without regard to age, gender, disability, race, religion, martial status, national origin, political affiliation, veteran status, or any other status protected by law and employ qualified persons based on the availability of positions and preference of consumers needing employees.



AUTHORIZATIONS

I authorize HAAS to contact any of my previous employers and any professional or academic references that I have given, and I authorize each of them to release to HAAS any information related to my position there. I also authorize HAAS to provide consumers seeking Personal Care Attendants with a copy of this application upon request, and to release information about my work history to the employers. I understand that HAAS has the right to suspend or remove me from employment as a Personal Care Attendant at any time with valid reason. I also understand that any false information provided on this application well be grounds for termination of employment.




Thank you for filling out an application to work for our company. We will review your application and get in touch with you.



Holistic Array of Authentic Services (HAAS)

Physical Office Address:
5851 Duluth st, Suite #302, Golden Valley, MN 55442

Mailing Address:
3813 51st Avenue North, Brooklyn Center, MN 55429

Office: 651-756-8492, Cell Phone; 612-275-9063 / Fax: 651 – 305 – 7170

E-mail: haas@haascares.com
Website: www.haascares.com
 

Contact Us

(763)353-0136

5851 Duluth st, Suite #302, Golden Valley, MN 55442

Mon. — Fri. 9:00am-5:00pm