Platinum Recruitment

1

Your Name:* This field is required.

First Name

Last Name

2

Your Phone Number:* This field is required.

3

Contact Email* This field is required.

4

Do you have an HHA or PCA certificate?* This field is required.

YESNO

5

Are you a US citizen or Authorized to work in the US?* This field is required.

I am a US citizen

I am authorized to work in the US

I am neither

6

Do you have a Social Security card?* This field is required.

YESNO

8

Do you speak any other languages?* This field is required.

YESNO

10

Hidden - secondary Languages

11

Hidden - all Languages

12

hidden - Speak English or Spanish or Russian

Yes

No

13

hidden - Speak French or Creole

Yes

No

Other

14

Hidden - Waitlist or Disqualified or Pass

Waitlist

Disqualified

Pass