Employment Application | Soleil Levant Care LLC | Caregiver Jobs Lake Elsinore CA

1. Position

2. Personal

3. Education

4. Certifications

5. Background

6. Employment

7. References

8. Statement

Position Information

Position Applying For *

Date Available to Start *

Desired Pay Rate ($/hr)

Employment Type Desired *

Days / Hours / Shifts Available *

Personal Information

Full Legal Name (Last, First, Middle) *

Date of Birth *

Street Address *

Apt / Unit #

City *

State *

Zip Code *

Home / Cell Phone *

Alternate Phone

Email Address *

Driver's License Number & State Required only if position involves transporting residents.

Social Security Number For DOJ/FBI background check clearance purposes only. Submitted securely over HTTPS.

Are you at least 18 years of age? (Required — Title 22, §85065)

Yes No

Are you legally authorized to work in the United States?

Yes No

Have you ever been employed by Soleil Levant Care before?

Yes No

If yes, when:

Do you have reliable transportation to and from the facility?

Yes No

Education

High School

School Name & Location

Years Completed

Diploma / Degree Earned

College / University

School Name & Location

Years Completed

Diploma / Degree Earned

Other / Vocational Training

School / Program Name & Location

Years Completed

Diploma / Certificate Earned

Certifications & Required Training

List all current certifications relevant to direct care work. Copies of current certificates must be provided prior to your first day of work.

CPR Certification — Issuer / Expiration Date

First Aid Certification — Issuer / Expiration Date

CPI Certification — Issuer / Expiration Date

DSP 1 Certification — Date Completed (if any)

DSP 2 Certification — Date Completed (if any)

Other Certifications / Training

ARF Core of Knowledge / Orientation Training — Dates Completed (if any)

Criminal Record & Background Disclosure (Title 22, §85065 / LIC 508)

State law requires all ARF employees to obtain criminal record clearance from the California DOJ and FBI (via Live Scan fingerprinting) before working in the facility. A criminal conviction does not automatically disqualify an applicant; DSS will determine eligibility on a case-by-case basis. Simple assault, minor traffic violations, and certain marijuana-related offenses generally do not need to be disclosed.

Have you ever been convicted of a crime (excluding minor traffic violations)?

Yes No

Is there currently any arrest or charge pending against you?

Yes No

If yes to either question above, provide details (nature of offense, date, location):

I understand that as a condition of employment, I must be fingerprinted (Live Scan) and clear a criminal background check through the DOJ/FBI and CCLD before having unsupervised contact with residents, and that I must complete a signed Criminal Record Statement (LIC 508) as part of my personnel file, per Title 22, §85065 and §85066.

Employment History

List your most recent employers first. Include any caregiving, healthcare, or residential-care experience.

Employer 1 — Most Recent

Employer Name

Phone Number

Supervisor Name

Employer Address

Position / Duties

Dates Employed (From – To)

Starting / Ending Pay

Reason for Leaving

May We Contact?

Yes No

Employer 2

Employer Name

Phone Number

Supervisor Name

Employer Address

Position / Duties

Dates Employed (From – To)

Starting / Ending Pay

Reason for Leaving

May We Contact?

Yes No

Employer 3

Employer Name

Phone Number

Supervisor Name

Employer Address

Position / Duties

Dates Employed (From – To)

Starting / Ending Pay

Reason for Leaving

May We Contact?

Yes No

References

Professional References

List two professional references (former supervisors or coworkers) who can speak to your work performance.

Professional Reference 1 — Full Name

Years Known

Relationship / Title

Phone Number

Professional Reference 2 — Full Name

Years Known

Relationship / Title

Phone Number

Personal References

List two personal references who are not related to you and have known you for at least one year.

Personal Reference 1 — Full Name

Years Known

Relationship

Phone Number

Personal Reference 2 — Full Name

Years Known

Relationship

Phone Number

Applicant Statement & Authorization

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading statement or omission may disqualify me from employment or result in termination if discovered later.

I authorize Soleil Levant Care to verify the information provided, including contacting former employers, schools, and personal references, and to obtain a criminal background / Live Scan clearance through the DOJ, FBI, and CCLD as required by Title 22.

I understand that, if hired, I will be required to complete all state-mandated training and criminal record clearance requirements applicable to ARF personnel before having unsupervised contact with residents.

I understand that employment, if offered, does not constitute a contract for a specific length of time and that employment is at-will unless otherwise stated in a signed written agreement.

Electronic Signature — By typing your full legal name below and submitting this application, you are acknowledging that you have read, understood, and agree to all statements above. This constitutes your electronic signature.

Full Legal Name (Electronic Signature) *

Date *

This application is submitted securely over an encrypted HTTPS connection. Your information will be received directly by the Soleil Levant Care hiring team at soleillevantcare@gmail.com. All information is kept strictly confidential and used solely for employment consideration purposes.

For Office Use Only — Do Not Complete

Date Application Received

Interviewed By

Interview Date

Hire Date

Live Scan / DOJ Clearance Date

References Checked (Y/N, Date)

Position / Rate Approved

Administrator Signature

EmploymentApplication

High School

College / University

Other / Vocational Training

Employer 1 — Most Recent

Employer 2

Employer 3

Professional References

Personal References

For Office Use Only — Do Not Complete

Employment
Application