We provide services 24 hours/day, seven days a week.
Please indicate which days of the week
you are available to work.
Include the earliest time and the latest time you would be willing and
able to work.

Workers may be required to transport clients and complete other tasks by vehicle.

Please check all tasks you have received training for and/or feel comfortable providing to both male
and female elders.

Start with your current or most recent job and list your employment history. You may attach a resume, however you must complete this application as well or you will not be considered for employment. Please include self-employment, volunteer experience, summer jobs, part-time jobs and hands-on care provided to family members.

I authorize the Alzheimer\’s Disease Resource Agency of Alaska, Inc., their staff and representatives to consult (via telephone or written communication) persons with whom I may have been associated including past and present employers and references who may have information pertinent to my competence, character and ethics. I release from liability all representatives of the Alzheimer\’s Disease Resource Agency of Alaska, Inc. for their acts performed in good faith and without malice in connection with evaluating my application.



I understand that Alzheimer’s Disease Resource Agency of Alaska may request information from public and private sources about my workers’ compensation injuries, driving record, court record, education, credentials, credit and references.



I authorize individuals, schools, companies and law enforcement authorities to release any information concerning my background. I release from liability all individuals, schools, companies and law enforcement authorities who provide information to the Alzheimer’s Disease Resource Agency of Alaska, Inc. in good faith and without malice concerning my competence, character, ethics and other qualifications.



I certify that I have read and understand the information and instructions on this form. That all statements made on this application are true and complete to the best of my knowledge. Any false statements, omissions, or misrepresentation of facts on this application or during interviews will subject me to disqualification or immediate dismissal at any time during employment.

Please provide a minimum of three (3) references, two of which must be previous or current supervisors

Alzheimer’s Resource of Alaska is an Equal Opportunity Employer. The information requested below is needed to fulfill Federal Employment Opportunity reporting requirements. Qualified persons are considered for employment without regard to race, color, religion, sex, national origin, marital status, age, or disability.

American Indian/Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent. This area includes China, Japan, Korea, Malaysia, the Philippine Islands, Thailand and Vietnam.
Black or African American-A person having origins in any of the black racial groups of Africa.

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

Native Hawaiian/Other Pacific Islander: A person having origins in any of the peoples of Hawaii Guam, Samoa or other Pacific Islands.

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Two or More Races: All persons who identify with more than one of the above five races.