Application Form

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment without regard to any factors prohibited by local, state, or federal law. Thank you for showing interest in SYNERGY HomeCare of South Dayton.

Personal Information

Section 1 - General Information

Section 2 - Employment Verification

Section 3 - Education

Section 4 - Caregiver Experience

Section 5 - Client Matching

Section 6 - Hours Available

Section 7 - Reference 1 (No family members allowed)

Section 8 - Reference 2 (No family members allowed)

Section 9 - Reference 3 (No family members allowed)

Section 10 - Emergency Contact Information

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

I understand that I am applying for a job with an independently owned and operated SYNERGY HomeCare Franchised Business providing home care services. The independently owned and operated SYNERGY HomeCare Franchised Business alone will control the terms and conditions of any potential employment and is not an agent of SYNERGY HomeCare Franchising, LLC. I acknowledge and agree that I am not applying for a job with SYNERGY HomeCare Franchising, LLC, a franchisor which does not offer home care services. 

Applicants are considered without regard to any factors prohibited by local, state, or federal law.