One of our representatives will happily contact you
within 24 hours. For urgent needs call us at

(517) 394-3389

Apply today

First Name*
Last Name*

Primary Phone*
Your email*
Zip code*

Optional: Upload your resume

Additional Information

Do you have a valid drivers license*?
Are you a veteran*? YesNo
Have you been convicted of a misdemeanor or felony*? YesNo
Highest Education Level* High SchoolEquivalentPost High School
Desired rate of pay

Availability Information

Days you are available to work* MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Times you are available to work* MorningsAfternoonsEvenings
You will be required to work two weekends per month or holidays as needed* Yes, I agreeNo, I do not agree
When can you start?*

Previous Employment

Company Name:

Company's Phone:

Dates Worked:

Salary or Hourly Wage:

Job Title:


Reason for Leaving:

May we contact this employer for a reference check?

Professional Work References

Please list at least 2 professional work references

Name of Work Reference:*

Company Name:*

Phone Number:*


Name of Work Reference:*

Company Name:*

Phone Number:*


Name of Work Reference:

Company Name:

Phone Number:


Release of Information

I, , allow my perspective employer Home Care Alternatives to verify information given to him or her on my application for employment and do hereby release Home Care Alternatives, State Police, and their assigns or successors from any liability of claims and authorize the State Police to release to Home Care Alternatives my conviction criminal history information.

Additional Last Names (ie: maiden or other married name)
Drivers License and/or State ID Number*
Issuing State*
Your date of birth*

Home Care Alternatives - Release and Consent for substance abuse testing

Certain clients of Home Care Alternatives require that employees assigned to it successfully pass a substance abuse test. As a condition for consideration for assignment, I voluntarily authorize any laboratory designated by HCA or its clients to conduct a test or test for the purpose of determining the presence of drugs or alcohol in my system. I also understand that I may be subjected to random drug screen as dictated by HCA.

Electronic Signature*


I am aware that federal law provides for imprisonment and/or fines for false statements of use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following)*:
A citizen of the United StatesA noncitizen national of the United StatesA lawful permanent residentAn alien authorized to work

Alien Registration Number (if applicable)

Sign and Submit

I confirm that the facts set forth in my application and submitted resume are true and complete to the best of my knowledge, that I shall ensure that such facts remain true and accurate for the duration of my employment with Home Care Alternatives.

Electronic Signature:*


At Home Care Alternatives we’ve been taking care of our community for more than 15 plus years. Our commitment to your health and safety have always been our priority. We are considered an essential business and remain open and here to help you and your family during the "Stay Home, Stay Safe" Order.


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