Kiku Home Health Care LLC - Your Home is Where Our Heart is

Office Manager Application

First Name *

Middle Name

Last Name *

SSN (XXX-XX-XXXX) *

Phone Number *

Street Address *

Apt/Floor No.

Zip Code *

State *

City *

Education

Institution Name

State

City

Degree

Year

Employment History

Employer

Location

Phone

Supervisor

Work Availability*

If "Other" Selected Please Specify or input "N/A"

Additional Information

Please list any and all areas of actual working experience and period of time during which experience was acquired (for example, ICU – one year, med surg, etc.):

Please explain, in detail, any periods of unemployment or reasons for leaving each employer:

Why are you interested in this position?

What special qualifications do you have that would be helpful in this position (e.g., speak a foreign language, proficient with specific computer programs)?

Type of license/certification, issuing authority and number, if applicable, license/certification expiration date:

Malpractice insurance carrier name, address, policy number, expiration date if applicable:

Professional References

Name

Address

Phone

Upload your resume

Upload Resume (DOCX/PDF, Max 5MB):

Declaration

Please read before signing:

My signature verifies that information provided in this application is true and complete. I understand the agency is an Equal Opportunity Employer. I understand that falsification, including withholding of information, on this application is grounds for immediate dismissal if I am selected for a position. I further understand that if I am hired, I can be terminated, with or without cause and with or without notice. I agree to have my picture taken for identification purposes and to submit to drug screening tests, upon request. I understand that all references listed above may be contacted in addition to past employers and educational institutions:

I hereby authorize KIKU HEALTH CARE to request and receive from all prior employers within one (1) year of the date of this application, any and all pertinent information concerning my prior employment and its termination, including the reasons for such termination.

Sign (Full Name)*

Date *

Contact Us

It would be great to hear from you! If you have any questions, please do not hesitate to send us a message. We are looking forward to hearing from you! We reply within 24 hours !

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Get in Touch

Kiku Home Health Care
2500 Morris Ave, Suite 200 Union, New Jersey 07083

Areas covered: We supply our services to the following counties:
Union County, Passaic County, Somerset County,
Bergen County, Essex County,
Hudson County, Middlesex County, and
Morris County, NJ

Phone: +1 (920) 220-0104
Fax: +1 (908) 676-6011

Kikuhhc@gmail.com

We Are Kiku Home Health Care