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Step 1: Employment Application Form

 A Peace of Mind Homecare, LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative. 


Please fill out all of the sections below: 

Applicant Information

Employment Position

Type of Employment
What days are you available to work?
What hours and shifts can you work?
Do you have reliable transportation to and from work?

Personal Information

Have you ever applied to or worked for A Peace of Mind Homecare, LLC before?
Do you have any friends, relatives, or acquaintances working for A Peace of Mind Homecare, LLC?
Are you 18 years of age or older?
Are you a U.S. Citizen or approved to work in the United States?
Have you ever been convicted of a criminal offense (misdemeanor or felony)?

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered. 

Job Skills / Qualifications

Note: A Peace of Mind Homecare, LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. 

Education & Training

Are you currently, or have ever been a member of the U.S. Armed Forces?
If yes, what branch(es) of services did you serve?

Previous Employment


Security / Background Check

Are you willing to do a background check?

At-Will Employment

The relationship between you and A Peace of Mind Homecare, LLC is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the A Peace of Mind Homecare, LLC. No representative of A Peace of Mind Homecare, LLC has authority to enter into any agreement contrary to the forgoing “employment at will” relationship. You understand that your employment is “at will”, and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company’s President. 

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