Mother Teresa House


Overnight Caregiver Application

Overnight Caregiver Application

  • Personal Information
  • Current Address
  • Contact Information
  • General Information
  • Education and/or Military

Personal Information

Current Address

Contact Information

General Information

Are you 18 years of age or older?

If you are under age 18, can you furnish a work permit?

Are you legally authorized to work in the United States?

Do you have any relatives working at the location where you are applying?

Note: Answering yes to the following two questions does not automatically disqualify you for the position.

Have you ever been convicted of a crime?

Have you ever been accused or arrested for physically, sexually, or emotionally abusing a child or an adult?

High School

Last Grade Completed

Graduate or GED?

College or University

Years Completed


College or University 2

Years Completed


Graduate School

Years Completed



Employment History

Please provide the following requested information regarding your employment history: Include military service assignments and volunteer activities. You may exclude organization names that include race, color, religion, gender, national origin, ancestry, age, disability or other protected status.

Current or Most Recent Employer

Are you currently employed?

Reason for leaving

OK to contact?

2nd Previous Employer

Reason for leaving

OK to contact?

3rd Previous Employer

Reason for leaving

OK to contact?

Applicant's Statement

I certify that all information I have provided in this application is true, complete, and correct.

I expressly authorize, without reservation, Mother Teresa House, its representatives, employees, or agents to contact and obtain information from all references, employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé, or job interview. I hereby waive any and all rights and claims I may have regarding Mother Teresa House, its representative, employees and agents for seeking, gathering, and using such information in the employment process and all other persons, entities, or organizations for furnishing such information about me.

I understand that Mother Teresa House does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable law.

If I am hired, I understand that employment is at-will. I understand that I am free to resign at any time, with or without prior notice, and that Mother Teresa House reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required or prohibited by applicable law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that any handbooks, manuals, policies, and procedures maintained by Mother Teresa House are not contractual in nature and may be amended or abolished at the sole discretion of the hiring agent. I understand that no supervisor or representative of Mother Teresa House is authorized to make any assurances to the contrary and that no implied, oral, or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by an authorized representative of Mother Teresa House.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

The employer is a human service organization.

This human service organization is faith based. In both personal and professional life, an employee must exemplify the moral teachings of the Catholic Church. The employee must not teach, advocate, model, or in any way encourage beliefs or behaviors that are contrary to the dogmatic or moral teachings of the Catholic Church, which can be found in the Catechism of the Catholic Church.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient cause to (a) eliminate consideration of this application, or (b) immediately terminate my employment whenever it is discovered.

This application shall be considered active for a period of time not to exceed 90 days.

I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.