First Name
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Last Name
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Address
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City
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State
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Postal code
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Phone
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Email
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Are you a...
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HHA (Home Health Aide)
CNA
LPN
RN
Do you have a car that you drive to and from work?
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Do you have a car that you drive to and from work?
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What days are you available to work?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What shifts are you available to work? (Check all that apply)
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Live-in (24 hours)
Morning: 7 am -3 pm
Afternoon: 3 pm - 11 pm
Evening 4 - 10 PM
Overnight: 11 pm-7 am
Day Shifts: 8 am -8 pm
Night shifts: 8 pm - 8 am
How did you hear about us?
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Special Skills
Why do you want to work with PlatinumCare+?
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