Change Inc-Employee Portal

Application for Direct Care Employment

Fields marked with a * are required.

If you would like to submit additional documentation (e.g. resume, reference, etc.), please fill out the following application, and click submit. All documentation can be sent by replying directly to the confirmation email you receive upon completion.  

Personal Details

Upon offer of employment we reserve the right to request Criminal Records. This does not automatically disqualify
you for employment.

You will be required to provide appropriate documentary evidence of this at the time of interview

You will be responsible for ensuring that you have the necessary vehicle insurance for use on business (If relevant to position)


Employment History

Previous Employment: Please include any previous experience (paid or unpaid), beginning with most recent

Employer 1

Employer 2

Employer 3

Special Interest/Hobbies


Please indicate your current availability


I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold Change Incorporated, any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.

Reference 1

Reference 2


I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have

provided is later found to be false or misleading, any offer of employment may be withdrawn or employment terminated. Further, I

understand that nothing in this application, or in any prior or subsequent written or oral statement, creates a contract of employment or

any rights in nature, of a contract. I agree and understand that if I am hired by Change Incorporated, my employment will be at-will, for

an indefinite period of time, and may be terminated at any time, with or without cause or notice, at the option of Change Incorporated or

myself. I understand that I have the right to end my employment at any time and that Change Incorporated retains that same right. I also

understand that no one has the authority to enter into any contract, agreement or modification of the foregoing unless such contract,

agreement or modification is in writing and signed by the president/human resources of Change Incorporated.