TOLL FREE: 844-853-5310
LOCAL: 715-387-8004
SERVICES 24 HOURS A DAY

Quality care in the comfort of your own home.

Marshfield Senior Services, Inc. is always in search of talented individuals to add to our staff. If you are a current CNA or PCW who is compassionate, experienced, and is looking to make a positive difference in someone’s life, we want to hear from you! Please fill out application below. We do not accept resumes in lieu of the application.

Thank you for connecting with us. We will respond to you shortly.

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Employment Application

By completing the following application, you are agreeing to be available for work every other weekend at a minimum.

First Name

Middle Initial

Last Name

Birthdate

Phone

Best time to call?

Morning

Afternoon

Evening

Address

City

State

Zip

Do you have a valid driver's license?

Yes

Are you currently employed?

Yes

How many years of experience do you have?

None

Less than 1 year

1 - 3 years

3 - 5 years

5 - 10 years

More than 10 years

What kind of work are you looking for?
Check all that apply.

Full-time

Part-time

Casual

How many hours a week are you looking for?
Check all that apply.

1 - 10

10 - 20

20 - 30

30 - 40

Employment History

Have you ever worked for Marshfield Senior Services, Inc. before?

Yes

If so, when?

Present or Most Recent Employer:

Current or Most Recent Employer Address

City

State

Date Started

Date Ended

Zip

Previous Employer

City

State

Date Started

Date Ended

Zip

Previous Employer

City

Zip

Date Started

Date Ended

State

Education

Name of High School and Location
Include address of High School

Year Graduated
If GED, enter year received.

Technical School / College

Please list any diplomas or certificates you currently hold.

Year Graduated

Are you a Veteran?

Yes

When did you serve?

Which Branch?

Discharge Type?

In 250 words or less, why would you like to work for us?

How did you hear about us?
Check all that apply.

Newspaper

Online Job Search

Employee Referral

Other

If you were referred by an employee or other, please tell us who.

Availability

Please select when you are available for work. If you are only available for short periods of time, please select the shifts that correspond to your availability. (First Shift = 6AM - 2PM; Second Shift = 2PM - 10PM; Third Shift 10PM - 6AM; None = not available for that particular day.)

New hires will be required to have availability to work every other weekend.

Mondays
Check all that apply.

First Shift

Second Shift

Third Shift

None

Fridays
Check all that apply.

First Shift

Second Shift

Third Shift

None

Tuesdays
Check all that apply.

First Shift

Second Shift

Third Shift

None

Saturdays
Check all that apply.

First Shift

Second Shift

Third Shift

Wednesdays
Check all that apply.

First Shift

Second Shift

Third Shift

None

Sundays
Check all that apply.

First Shift

Second Shift

Third Shift

Thursdays
Check all that apply.

First Shift

Second Shift

Third Shift

None

TOLL FREE: 844-853-5310 LOCAL: 715-387-8004 SERVICES 24 HOURS A DAY

Quality care in the comfort of your own home.

Employment Application

Employment History

Education

Availability

TOLL FREE: 844-853-5310
LOCAL: 715-387-8004
SERVICES 24 HOURS A DAY