• Welcome to Healthcare Plus Online Application

    The information here will be used to autofill the paperback application. Please answer every question that shows an *

  • Employee Application

    This section will Fill out the majority of the general information needed.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Today's Date *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Format: (000) 000-0000.
  • Are you 18 years of age or older?*
  • Are you Currently authorized to work in the U.S.?*
  • If selected for employment, are you willing to be fingerprinted?*
  • Have you ever filed an application with us before*
  • Have you ever been dismissed from employment?*
  • Have you ever been employed with us before*
  • If selected for employment, can you provide a valid driver's license and insurance?*
  • Did You Graduate?*
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  • Staffing Questionnaire

    This section will Fill out your Staffing Questionnaire section of your application and help us find the clients that work best with your schedule
  • What's your availability to work?
    Rows
  • Do you have a pending/potential client?
  • Do you smoke?
  • Can you work for someone who smokes?
  • What languages do you speak?
  • Are you pet friendly? ( Select all that apply)
  • How would you like to be addressed?
  • Have you ever received a dose of COVID-19 Vaccine?
  • Have you ever had a Positive test for COVID-19

  • Policy & Procedures

    This section will Fill out your Policy & Procedures section of your application

  • Employee Handbook

  • W-4 Forms

    This section will Fill out your W-4 section of your application. This will fill out the required parts, to fill out a comprehensive W-4 parts that might not be included here, please fill out a paper application at your nearest office.
  • Filing Taxes as*

  • Tax Withholding Estimator

    https://www.irs.gov/individuals/tax-withholding-estimator

  • IRS Worksheet

    https://www.irs.gov/pub/irs-pdf/fw4.pdf
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  • Step 4 (optional, Image above): Other Adjustments. Will you be Claiming other adjustments*
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  • Will you be filling out Section 2(b) (Image above, optional)*
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  • Will you be filling out Step 4(b) (Image above, optional)*
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  • I-9 & Background

    This section will Fill out your !-9 & Background section of your application. Most of the information in this part has already been filled out using your information from step 1
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  • I attest, under penalty of perjury, that I am (check one of the following boxes):*
  • Alien authorized to work until: (expiration date)*
     - -
    2 digit month, 2 digit day, 4 digit year

  • I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in  connection with the completion of this form.   

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  • Gender*
  • Have you ever had an administrative finding of Abuse, Neglect or Theft?*
  • Have you ever been convicted of a criminal offense other than a minor traffic violation (do not include convictions that have been expunged, sealed or adjudicated  delinquent)*

  • I certify that the above is true and correct and give my consent for my name to appear on Department’s Health Care Worker Registry with the results of my criminal history records check.

  • Would you like to sign up for direct deposit?
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  • Required Documents

    In this section you will submit the three required documents needed for your application. Please Submit documments on a solid background
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