Application Form

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.

 

To work with Synergy HomeCare you must have the following:

  • You MUST have your OWN Vehicle - Borrowing a car and getting dropped off at assignments is NOT ACCEPTABLE! 
  • First Aid Certification
  • CPR Certification 
  • Any Licenses/Certifications (CNA, HHA, RN, etc)
  • Auto Insurance (with you listed as an insured person)
  • Evidence of a 2 Step TB Test
  • Any previously run background checks (example: ChildLine, State Police, etc)
    • Please note that the State of Pennsylvania now requires that all homecare applicants go through a battery of background checks. Please understand that once completed, these can be used for application at any homecare agency in the state.  

Personal Information

Section 1 - General Information

Section 2 - Employment Verification

Section 3 - Education

Section 4 - Getting To Know You Better!

Section 5 - Most Recent Employment

Section 6 - Previous Employer

By submitting this application electronically, I hereby certify that the answers given by me to all of the questions contained on this application form are true and correct to the best of my knowledge. If employed by Synergy HomeCare, I will comply with all rules and regulations of the company. I agree to submit to a physical and or drug examination if required. I also authorize my former employers to give any information they have regarding me to Synergy HomeCare, whether or not it is on their records. I authorize Synergy HomeCare to conduct any background checks necessary including, but not limited to: Felony and Misdemeanor convictions, previous arrest history, and driving records (DMV). I hereby release Synergy HomeCare from all liability for and damage whatsoever for issuing the same. I understand that if any fraudulent information is given on this application, it will be grounds for immediate termination from my position. Synergy HomeCare is an Equal Opportunity Employer. I understand that job positions are placed equally without discrimination because of race, creed, color, religion, sex, national origin, sexual preference, handicap, or age.