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Can I Use Long Term Care

Insurance?

Many people have purchased long term care insurance (LTCI) polices in recent years. Most people think they need to be admitted to a nursing home to use their policy's coverage. However, many LTCI policies provide coverage for home care if an insured client needs hands on help with bathing, dressing, walking, or other kinds of personal care assistance.

At Berkshire Home Care, we have experienced home care professionals that can assist you to understand your coverage and possibly help you obtain the care you need to remain in your own home for the short term or forever!

Come home with us...
Lee Regional VNA
and
Stay home with us...
Berkshire Home Care

JOB APPLICATIONS

We appreciate your interest in Berkshire Home Care Inc. To ensure that we obtain a clear understanding of your qualifications and background, please be sure to complete the entire application. Thank you for your cooperation and interest in Berkshire Home Care.

An asterisk indicates a required field.*
*Personal Information:
*First Name
*Last Name
Middle Name
*Date of Birth
*Address
*City
*State	*Zip
*Phone: Daytime
*Evening
*Email Address
*Are you currently employed?	Yes No
May we contact your employer?	Yes No
*When are you available to work? (state days and hours)
*Could you start work right away?	Yes No
If not please provide starting date
*Do you have a driver's license?	Yes No
If so, please enter DL#
*Are you on any medication?	Yes No
If so, please list
*Employment Experience: Start with your present or last job. Include any job-related military service assignments and volunteer work/activities.
Employer #1: Employer Name
Salary/Wage
Phone of Employer
Address
City
State	Zip
Your Job Title & Principle Duties
Reason for leaving
Employer #2: Employer Name
Salary/Wage
Phone of Employer
Address
City
State	Zip
Your Job Title & Principle Duties
Reason for leaving
Employer #3. Employer Name
Salary/Wage
Phone of Employer
Address
City
State	Zip
Your Job Title & Principle Duties
Reason for leaving
Employer #4. Employer Name
Salary/Wage
Phone of Employer
Address
City
State	Zip
Your Job Title & Principle Duties
Reason for leaving
*List professional, trade, business or civic activities and offices held:
*Summarize special job related skills and qualifications acquired from employment or other experience that relate to home care:
References #1: *Name
*Address
*City
*State	*Zip
*Phone
References #2: *Name
*Address
*City
*State	*Zip
*Phone

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