P.O. Box 866, Three Rivers, CA 93271 • 559-936-3054

    Comforting Assistance 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

    Position(s) applying for: CNA / Caregiver circle one (a license is not required)

    Personal Information

    Job Skills/Qualifications (Must Have A Current CPR card to begin working)

    Please list below the skills and qualifications you possess for the position for which you are applying:

    (Note: Comforting Assistance complies with the ADA and considers reasonable accommodation measures
    that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a
    hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical

    Education and Training

    High School

    Location (City, State)
    Year Graduated
    Degree Earned


    Location (City, State)
    Year Graduated
    Degree Earned

    Vocational School/Specialized Training

    Location (City, State)
    Year Graduated
    Degree Earned


    Previous Employment #1

    Previous Employment #2

    Previous Employment #3


    Please provide 3 personal and professional reference(s) below:


    Contact Information

    Additional Information:


    The relationship between you and the Comforting Assistance 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 Comforting Assistance. No representative of Comforting Assistance has
    authority to enter into any agreement contrary to the foregoing "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 a representative of this company.