Job Application – Cromartie Group Home

Welcome to Cromartie Group Home Inc.

Thank you for your interest in joining our team! This application takes approximately 15-20 minutes to complete.

Equal Opportunity Statement
Prospective employees will receive consideration without discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, and gender identity), national origin, age, disability, genetic information, veteran/military status, or any other characteristic protected by federal, state, or local law. We are committed to providing reasonable accommodations for qualified individuals with disabilities and maintaining an inclusive workplace where all employees can thrive.

Questions?

We're here to help!
📞 Call us: (305) 621-6324
📧 Email: cromartieinc@gmail.com
⏰ Business Hours: Monday-Friday, 9:00 AM to 5:30 PM

Requried Pre- Employment Documentation

The following documents are required for interview consideration. Please contact us if you have any questions.

Completed Employment Application Local Background Check *Obtained from your local police department Attestation of Good Moral Character *To be completed in our office] Valid Driver License/ID Resident Card/Alien Card (if applicable) Social Security Card High School Diploma or GED Transcript (official or unofficial) Level II Background Check *(Live Scan/Fingerprints) [Can be completed at a Live Scan provider of your choice. While we partner with a Live Scan provider at our facility for your convenience, this is a separate service from our group home. You can schedule your Live Scan appointment at our facility here: https://book.squareup.com/appointments/xf7vghvidhh5i8/location/LJHHQSDH1C9F4/services/ZKY7AGM6FE4Z4LYTVWRF3N7H Three (3) Letters of Reference * [must include a date, signature, and contact information]

Hello there!

Required Online Certifications

Required online certifications must be completed before employment begins. These can be obtained through the Florida Agency for Persons with Disabilities (APD) training portal at: https://apd.myflorida.com/providers/training/

Zero Tolerance Training

Direct Care Core Competency

HIPAA Training

Additional Required Certifications (if applicable)

While the following certifications are not required prior to employment, obtaining them within 90 days of hire will be necessary. Early completion may expedite your application process:

CPR

First Aid

Administering Medication (Validation 65G7)

Document Verification Agreement

To initiate employment with Cromartie Group Home, Inc., all required documentation listed above must be submitted and verified prior to beginning work duties. For any questions regarding these requirements, please contact our office at (305)621-6324. Timely submission of all required documents will expedite your employment consideration process. My signature below confirms that I have read the above statements and agree to submit all required documents in a timely manner.

Print Name:

Signature:

Date:

First Name:

Last Name:

Middle Name (If Applicable):

Date Of Birth:

Email Address

Address:

Cell telephone #:

Home telephone #:

Business telephone #:

Have you ever applied for employment with us?

Yes No

If yes: Month and Year

Location

Position Desired

Direct Service Provider Group Home Manager Office Personal

Locations Available

Hillsborough, Tampa Miami Gardens, Miami

Schedule Availability

Physical Requirements and Workplace Expectations

This job may require standing, walking, or assisting individuals with physical needs. Are you comfortable fulfilling these requirements?

Yes No

Are you able to lift a minimum of 75 pounds?

Yes No

In case of emergencies or staff shortages, employees may be required to stay beyond their scheduled shift. Are you willing to stay over when necessary?

Yes No

Per Florida Statute 393.13 and agency policy, employees are legally required to remain at their post until proper coverage arrives to ensure continuous care for our residents. This mandatory stay-over policy is essential for maintaining the safety and well-being of our clients. Do you understand and agree to comply with this legal requirement?

Yes No

Preferred Shift:

1st Shift (7:00 am- 3:30 pm) 2nd Shift (3:00 pm - 11:30 pm) 3rd Shift ( 11:00 pm - 7:30 am) PRN (Per Required Need/As Needed) Staff (All the information in blue should only show up if someone chooses the PRN option)

What is your availability:

Days Available to Work (Check all that apply):

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Shift Availability:

Morning (7:00 AM - 3:30 PM) Afternoon (3:00 PM - 11:30 PM) Overnight (11:00 PM - 7:30 AM)

Additional Information: Are you available for emergency on-call?

Yes No

Background Information

Are you legally eligible for employment in the United States?

Yes No

When will you be available to begin work?

Have you been convicted of any crimes in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court?

Yes No

If "Yes," describe in full.

Have you ever been bonded?

Yes No

If "Yes," with what employers?

Other special training or skills (languages, machine operation, etc.)

References

Reference #1

Name

Relationship

Phone

Email (if applicable)

Reference #2

Name

Relationship

Phone

Email (if applicable)

Reference #3

Name

Relationship

Phone

Email (if applicable)

High School

Name & Location of School

Course of Study

Number of Years Completed

Did you Graduate?

Yes No

Degree or Diploma

Business/Trade/Technical

Name & Location of School

Course of Study

Number of Years Completed

Did you Graduate?

Yes No

Degree or Diploma

College/University

Name & Location of School

Course of Study

Number of Years Completed

Did you Graduate?

Yes No

Did you serve in the U.S. Armed Forces?

Yes No

If Yes, in what branch?

Describe any training received relevant to the position for which you are applying.

Please read and understand this statement before signing your application: The information I have provided in this Application for Employment is true, correct and complete. False, incomplete, or misrepresented information of any kind will be sufficient cause for my application to be rejected or, if discovered after employment, cause for immediate termination. I authorize the employer to contact and obtain information about me from previous employers, educational institutions, "references" I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, resume, or personal interview. To assist in processing my application, I waive all rights and claims against the employer or its representatives for seeking and using information to evaluate my employment request, and against all other persons, corporations, or organizations who provide information for this purpose. This application will expire in 60 days. After that date, unless otherwise notified, I understand my status as an applicant will end. I may re-apply for employment by completing a new application. This application is not an employment agreement. If I accept an offer of employment, I understand I may resign at any time, and the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that only an executive officer of the employer has authority to enter into any employment agreement with terms contrary to the foregoing, and then only in writing signed by such officer. I fully understand and accept all terms and conditions in the above statement.

Name

Signature

Date

Print This Application by Clicking HERE

Welcome to Cromartie Group Home Inc.

Questions?

We're here to help!
📞 Call us: (305) 621-6324
📧 Email: cromartieinc@gmail.com
⏰ Business Hours: Monday-Friday, 9:00 AM to 5:30 PM

Requried Pre- Employment Documentation

The following documents are required for interview consideration. Please contact us if you have any questions.

Completed Employment ApplicationLocal Background Check [Obtained from your local police department]Attestation of Good Moral Character [To be completed in our office]Valid Driver License/IDResident Card/Alien Card (if applicable)Social Security CardHigh School Diploma or GED Transcript (official or unofficial)Level II Background Check *(Live Scan/Fingerprints) [Can be completed at a Live Scan provider of your choice. While we partner with a Live Scan provider at our facility for your convenience, this is a separate service from our group home. You can schedule your Live Scan appointment at our facility here: https://book.squareup.com/appointments/xf7vghvidhh5i8/location/LJHHQSDH1C9F4/services/ZKY7AGM6FE4Z4LYTVWRF3N7HThree (3) Letters of Reference [must include a date, signature, and contact information]

Required Online Certifications

Zero Tolerance Training

Direct Care Core Competency

HIPAA Training

Additional Required Certifications (if applicable)

While the following certifications are not required prior to employment, obtaining them within 90 days of hire will be necessary. Early completion may expedite your application process:

CPR

First Aid

Administering Medication (Validation 65G7)

Document Verification Agreement

Print Name *

Signature *

Date *

First Name *

Middle Name

Last Name

Date of Birth

Email Address

Street Address

City

State/Province

ZIP / Postal Code

Country

Cell Phone #

Home telephone #:

Business telephone #:

Have you ever applied for employment with us?YesNo

If yes: Month and Year

Location

Desired PositionDirect Service ProviderGroup Home ManagerOffice Personal

Locations AvailableHillsborough, TampaMiami Gardens, Miami

Schedule Availability

Physical Requirements and Workplace Expectations

This job may require standing, walking, or assisting individuals with physical needs. Are you comfortable fulfilling these requirements?YesNo

Are you able to lift a minimum of 75 pounds?YesNo

In case of emergencies or staff shortages, employees may be required to stay beyond their scheduled shift. Are you willing to stay over when necessary?YesNo

Preferred Shift1st Shift (7:00 am- 3:30 pm)2nd Shift (3:00 pm - 11:30 pm)3rd Shift ( 11:00 pm - 7:30 am)PRN (Per Required Need/As Needed) Staff (All the information in blue should only show up if someone chooses the PRN option)

What is your availability?

Days Available to Work (Check all that apply)MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Shift AvailabilityMorning (7:00 AM - 3:30 PM)Afternoon (3:00 PM - 11:30 PM)Overnight (11:00 PM - 7:30 AM)

Additional Information: Are you available for emergency on-call?YesNo

Background Information

Are you legally eligible for employment in the United States?YesNo

When will you be available to begin work?

Have you been convicted of any crimes in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court?YesNo

If "Yes," describe in full.

Have you ever been bonded?YesNo

If "Yes," with what employers?

Other special training or skills

References

Name

Relationship

Phone

Email Address (if applicable)

High School

School Name

School Locations

Course of Study

Number of Years Completed

Did you Graduate?YesNo

Degree or Diploma

Business/Trade/Technical

School Name

School Locations

Course of Study

Number of Years Completed

Did you Graduate?YesNo

Degree or Diploma

College/University

School Name

School Locations

Course of Study

Number of Years Completed

Did you Graduate?YesNo

Degree or Diploma

Graduate

School Name

School Locations

Course of Study

Number of Years Completed

Did you Graduate?YesNo

Degree or Diploma

Employment

Please give accurate, complate full-time and part-time employment record. Start with your present or most recent employer.

Company

Company Name

Phone Number

Address

Employment (Started)

Employment (Ended)

Name of Supervisor

Weekly Pay (Start)

Weekly Pay (End)

Job Title

Describe Your Work

Reason for Leaving

Military

Did you serve in the U.S. Armed Forces?YesNo

If Yes, in what branch?

Describe any training received relevant to the position for which you are applying.

Name *

Signature *

Date Applied *

Welcome to Cromartie Group Home Inc.

Questions?

Requried Pre- Employment Documentation

Required Online Certifications

Additional Required Certifications (if applicable)

Document Verification Agreement

Schedule Availability

What is your availability:

Background Information

References

High School

Business/Trade/Technical

College/University

Graduate

Employment

Company Name

Company Name

Company Name

Company Name

MILITARY

Print This Application by Clicking HERE

Welcome to Cromartie Group Home Inc.

Questions?

All rights reserved Cromartie Group Home Inc.