Charity Care | Helping Hands
Long Term Care Insurance
Medicaid Waiver Services
Personal Care Services
Private Pay Services
Veteran’s In-Home Services
Worker’s Compensation In-Home Services
We have a great team on board and invite you to join us! Please answer the following questions completely and we will be in touch.
To which of our offices/locations are you applying?
Your mailing address
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
On what date are you available to begin work?
What days/hours would you be available to work?
Which of the following certifications do you have? (check all that apply)
What other certifications or licenses do you hold?
In which West Virginia counties are you willing/able to work? (please check all that apply)
Please check if you have...:
a current auto insurance policy
a valid WV driver's license
worked for us or similar agency before
Please list the high school you attended, and whether you graduated.
Please list any vocational training, the major course(s) of study, and any certificates or degree received.
Please list any colleges attended, the major course(s) of study, and any certificates or degrees received.
Please start with your present or most recent employment first.)
Present/most recent Employer: Please list Employer name, address, phone, supervisor name, the dates employed, your title/duties, reason for leaving, and start/end salary.
Employer #2: Please list Employer name, address, phone, supervisor name, the dates employed, your title/duties, reason for leaving, and start/end salary.
Employer #3: Please list Employer name, address, phone, supervisor name, the dates employed, your title/duties, reason for leaving, and start/end salary.
Employer #4: Please list Employer name, address, phone, supervisor name, the dates employed, your title/duties, reason for leaving, and start/end salary.
Please list any other abilities, knowledge, or training that might be helpful to us in considering your application.
Please list at least three (3) references, including name/phone number for each. Please do not include relatives or family members.
If you have ever been convicted of a felony or misdemeanor, please describe the charges below.
Our agency conducts routine checks on any prospective employee through the Criminal Investigation Bureau/Magistrate’s/Circuit Clerk. By submitting this application you are consenting to the release of this information. Disclaimer: A conviction record will not necessarily bar an applicant from employment. I hereby give Central West Virginia Aging Services, Inc., permission to conduct a criminal background check from any and all sources. I hereby certify that all information given by me in this application is true and correct to the best of my knowledge. I hereby give my consent for Central West Virginia Aging Services, Inc., to contact the references I have listed. SUBMITTING YOUR APPLICATION To submit your application to us, please press the submit button below. You will receive a confirmation email at the email address you provided to us. If you do not receive an email, please make sure you have whitelisted centralwvaging.org, and check your "junk" or "spam" folder.
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