Employment Application

We look forward to hearing from you.

Employment Application Information

If you wish to apply, you can download either the Napa or Lake County PDF application (see buttons below) to fill in and send back (mail or fax); or you can use our online application further down the page.

Napa Office

905 Jefferson St., Napa, CA 94559
Office: 707- 259-0526
Fax: 707-266-1199
Hiring Manager: Arnab Chakrabarti
arnabc@tailoredlivingchoices.com

Download Napa Office Employment Application

Lake Office

916 N. Forbes St., Lakeport, CA 95453
Office: 707-900-2126
Fax: 707-263-3895
Office Manager: Charles Thomas
Charlest@tailoredlivingchoices.com

Download Lake Office Employment Application

Online Application

This is a long form requiring lots of information. We recommend you have your information ready before starting to fill it out. You can download the pdf version using one of the links above to see what information will be required.

Step 1 of 5 - Personal Information

20%

Current Personal Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Phone Type(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you 18 years or older?(Required)

Yes

Desired Employment

Position(Required)

Date you can start(Required)

MM slash DD slash YYYY

Salary Desired(Required)

Are you currently employed?(Required)

Yes

May we contact your current employer?(Required)

Yes

Have you ever worked as a caregiver?(Required)

Yes

Where and When?(Required)

What was your reason for leaving?(Required)

Have you ever been employed with Tailored Living Choices in the past? If so, when, and what was the reason for you leaving?(Required)

Do you have any relatives currently employed with TLC? If so, please list them here:(Required)

How did you hear about us?(Required)

Which location are you applying for?(Required)

Napa County

Lake County

Availability Napa County

What is your availability? TLC runs three shifts a day, seven days a week. Generally, and subject to client program needs, day shifts are generally 8 hours long beginning at 7am or 8am, Afternoon shifts are generally 7 hours long beginning between 2pm and 4pm and overnight/sleep shifts are generally 10 hours long and begin between 9pm and 11pm. Please check the box indicating which shifts you are available to work.

Morning Shift

Sunday 8am to 3pm

Monday 8am to 3pm

Tuesday 8am to 3pm

Wednesday 8am to 3pm

Thursday 8am to 3pm

Friday 8am to 3pm

Saturday 8am to 3pm

Afternoon Shift

Sunday 3pm to 10pm

Monday 3pm to 10pm

Tuesday 3pm to 10pm

Wednesday 3pm to 10pm

Thursday 3pm to 10pm

Friday 3pm to 10pm

Saturday 3pm to 10pm

Night Shift

Sunday 10pm to 8am

Monday 10pm to 8am

Tuesday 10pm to 8am

Wednesday 10pm to 8am

Thursday 10pm to 8am

Friday 10pm to 8am

Saturday 10pm to 8am

Availability Lake County

Morning Shift

Sunday 7am to 3pm

Monday 7am to 3pm

Tuesday 7am to 3pm

Wednesday 7am to 3pm

Thursday 7am to 3pm

Friday 7am to 3pm

Saturday 7am to 3pm

Afternoon Shift

Sunday 3pm to 11pm

Monday 3pm to 11pm

Tuesday 3pm to 11pm

Wednesday 3pm to 11pm

Thursday 3pm to 11pm

Friday 3pm to 11pm

Saturday 3pm to 11pm

Night Shift

Sunday 11pm to 7am

Monday 11pm to 7am

Tuesday 11pm to 7am

Wednesday 11pm to 7am

Thursday 11pm to 7am

Friday 11pm to 7am

Saturday 11pm to 7am

This field is hidden when viewing the form

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Are there any permanent scheduling commitments you currently have which impact your availability? If so, please list them here:

Education

If you have a resume or CV that contains some of the information below, you may upload it here and skip those sections below. However please BE SURE that you review this entire form and that all of the information we ask for is included.

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 1 GB.

High School

Institution

# of Years

Did you Graduate?

Subjects Studied

College

Institution

# of Years

Did you Graduate?

Subjects Studied

Trade or Business

Institution

# of Years

Did you Graduate?

Subjects Studied

You can click the + icon to add more.

Military Experience

Dates of Service

Rank Achieved

Duties Performed

Are there subjects of special study or research work you have done that you believe will support your success in this position?

Do you have CPR, First Aid, Pro-Act or any other training or certifications you believe will support your success in this position?

Are there other specialized skills you have which you believe would support your success in this position?

Current / Former Employers

List below the LAST 5 CONSECUTIVE employers starting with the most recent one first

Name of current or most recent employer

Current or most recent employer

Address

City

State

Zip

Current or most recent employer

Starting Date

Leaving Date

Your Job Title

Current or most recent employer

Name of Supervisor

Supervisor Title

Phone

Description of work (most recent employer)

Reason for leaving (most recent employer)

2nd Most Recent Employer

Name of 2nd most recent employer

2nd most recent employer

Address

City

State

Zip

2nd most recent employer

Starting Date

Leaving Date

Your Job Title

2nd most recent employer

Name of Supervisor

Supervisor Title

Phone

Description of work (2nd most recent employer)

Reason for leaving (2nd most recent employer)

3rd Most Recent Employer

Name of 3rd most recent employer

3rd most recent employer

Address

City

State

Zip

3rd most recent employer

Starting Date

Leaving Date

Your Job Title

3rd most recent employer

Name of Supervisor

Supervisor Title

Phone

Description of work (3rd most recent employer)

Reason for leaving (3rd most recent employer)

4th Most Recent Employer

Name of 4th most recent employer

4th most recent employer

Address

City

State

Zip

4th most recent employer

Starting Date

Leaving Date

Your Job Title

4th most recent employer

Name of Supervisor

Supervisor Title

Phone

Description of work (4th most recent employer)

Reason for leaving (4th most recent employer)

5th Most Recent Employer

Name of 5th most recent employer

5th most recent employer

Address

City

State

Zip

5th most recent employer

Starting Date

Leaving Date

Your Job Title

5th most recent employer

Name of Supervisor

Supervisor Title

Phone

Description of work (5th most recent employer)

Reason for leaving (5th most recent employer)

3 References

Below please provide the names of THREE PERSONS you are not related to whom we may speak regarding your application.

PLEASE CLICK THE + TO CREATE 3 ROWS for 3 separate references(Required)

Name

Address and Phone Number

Business

Years Aquainted

Background Check

We are required by the Department of Social Services to screen caregivers through a Department of Justice fingerprint background check. Do you consent to a background check upon offer of employment?(Required)

Yes

We are required to provide staff for Regional Center clients who are able to assist the client in community integration, independent living and emergency transportation. You must have reliable, independent, properly insured transportation, a valid California driver’s license and the willingness, upon hire, to produce a DMV printout of your driving record. Final scheduling and suitability for hire decisions may be based in part on the status of your driving privileges and your moving violation history.

Do you have a valid California driver’s license?(Required)

Yes

Do you have a reliable, properly insured vehicle at your disposal while on shift and proof of insurance and proof of car registration?(Required)

Yes

Tailored Living Choices requires that employees be reachable while on shift and provides a cell phone stipend to offset the cost. Do you have a working cell phone?(Required)

Yes

Please provide the number you use for work purposes here:(Required)

Equal Opportunity Employer

Tailored Living Choices provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Tailored Living Choices complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Tailored Living Choices expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Tailored Living Choice’s employees to perform their job duties may result in discipline up to and including discharge.

Authorization(Required)

I agree

I certify that the information in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements made on this application are grounds for immediate dismissal.

I authorize the investigation of all statements contained herein, the references, and employers listed above to give you all information concerning my previous employment. All pertinent information they have may have personal and/or otherwise releases the company from any and/or all liability for damages that may result from utilization of such information.

I also understand and agree that no representative of the company has any authorization to enter into any agreements for employment for any specified period, and/or to make any agreement contrary to the forgoing, unless it is in writing and an authorized company representative signs it.

Signature(Required)

Today's Date(Required)

MM slash DD slash YYYY