Careers

Employment Application

About ten minutes. Fields marked with * are required. If something does not apply to you, leave it blank — we would rather have an incomplete application than none at all.

Jade Community Care, Inc. Home and Community Based Services

Employment Application 1237 Crabb River Road, Ste C
Richmond, TX 77469 · (713) 447-0726

A note on what we ask for. This form deliberately does not ask for your Social Security number, date of birth, or driver's license number. We collect those on paper when you come in, so they are never sent across the internet. Please do not type them into any box below.

This is the first step, not the last one. If we move forward with your application, there is more paperwork to complete before your first day — background check and registry authorizations, I-9 and W-4, a TB screening, and Jade's policy acknowledgements. We will give you that packet in person and walk you through it. Nothing else is needed from you today.

Position What you are applying for

Position applying for

Employment type

Date available to start

Desired pay Hourly or salary — a range is fine

Shifts you are available for Check every shift that works for you.

About You How we reach you

First name

M.I.

Last name

Phone

Street address

Apartment / unit

City

State

ZIP

How did you hear about us?

Who referred you? If someone did

Emergency Contact Someone we can reach if we cannot reach you

Name

Relationship to you

Phone

Work Eligibility & Driving Required for every position

Are you legally authorized to work in the United States?

Yes

Are you 18 years of age or older?

Yes

Do you have a valid driver's license and current auto insurance? Most of our positions require driving the people we serve to appointments and activities. Please do not type your license number — we take that in person.

Yes, both

License only

Neither

Driver's license expiration Month and year only

Auto insurance expiration Month and year only

Do you have reliable transportation to work?

Yes

Are you willing to complete a criminal background check and the registry checks Texas requires? Employee Misconduct Registry, Nurse Aide Registry where applicable, and a TB screening. Required by state rule for everyone who works with the people we serve.

Yes

Have you ever been convicted of a felony? A conviction does not automatically disqualify you. Texas rule bars certain offenses from this work; everything else we consider individually, looking at what happened, when, and what has changed since.

Yes

If yes, please explain

Current Employment & Jade History

Are you currently employed?

Yes

May we contact your current employer?

Yes

Not applicable

Have you ever worked for Jade Community Care?

Yes

If yes, when?

Position and location

Have you previously applied to Jade Community Care?

Yes

If yes, when?

Education & Credentials

Highest level of education completed

School name

Current licenses and certifications Check anything you hold right now. We pay for CPR and First Aid if you do not have them.

License number If you hold a nursing license

License expiration

Experience Your two most recent employers

Employer 1

Employer name

Your job title

From

Employer phone

Reason for leaving

Employer 2

Employer name (optional)

Your job title

From

Employer phone

Reason for leaving

Have you worked with people with intellectual or developmental disabilities before?

References Two professional references, please

Reference 1

Name

Relationship to you

Phone

Reference 2

Name

Relationship to you

Phone

In Your Own Words

Why do you want to work at Jade Community Care? A few sentences is plenty. We read every one of these.

Anything else we should know? Scheduling constraints, a position not listed above, a gap in your work history — anything you want to explain up front.

Attach your resume Optional. PDF or Word, up to about 5 MB. You do not need a resume to apply.

Signature

I certify that the information on this application is true and complete. I understand that false or incomplete information may disqualify me from employment or result in termination.

I understand that this application is not an offer or a contract of employment, and that employment with Jade Community Care, Inc. is at will. I authorize Jade Community Care to contact the references and former employers I have listed, and to complete the background and registry checks required by Texas Health and Human Services before I begin work.

I understand that if my application moves forward I will be asked to complete additional employment forms and authorizations before my first day of work.

I have read and agree to the statement above.

Type your full name as your signature

Today's date

Submitted online at jadecommunitycare.com · Confidential Employment Record

Want a copy for your own records? Use this before you submit — it prints your completed application on Jade letterhead.

Trouble with this form? Email your resume to careers@jadecommunitycare.com or call (713) 447-0726.

Jade Community Care, Inc. is an equal opportunity employer.