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We're hiring

We are a growing practice of diverse, passionate and dedicated staff. If you care about the people you work with, we would like to meet you.

Talk to us today

Mon–Fri, 9:00 AM – 5:00 PM

Serving6 counties in New Jersey

Position

Position type *

Your details

Full name *

Other names or nicknames

Address *

Home phone *

Cell phone *

SS # — last 4 digits

Date of birth

Email address *

Emergency contact

Full name *

Cell phone *

Background

Have you ever been employed by Pristine Home Health Care before? Yes No

Have you ever filed an application with Pristine Home Health Care before? Yes No

Are you 18 years or older? Yes No

Are you a U.S. citizen? Yes No

Are you currently employed? Yes No

May we contact your present employer? Yes No

If you worked with us before, when?

Work availability

Start date

Days of the week Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Live-in Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Shifts Days Evenings Nights

Do you have a car? Yes No

Do you use public transportation? Yes No

Licensure and certification

Licensure RN LPN Social Worker PT OT ST

Certification CHHA CNA

Special certifications

License or cert #

State

Board / licensing authority

Expiration date

Malpractice insurance policy # — if applicable

Expiration date

Carrier name and address

Do you speak, read and understand English? Yes No

What foreign languages do you speak, read or write?

Previous employment

Please include name, address, telephone number, position held, dates, supervisor's name and title, along with the reason for leaving. Include your last position and at least one year of prior work history.

Employer 1

Reason for leaving Lack Work Termination Other

Employer 2

Reason for leaving Lack Work Termination Other

Employer 3

Reason for leaving Lack Work Termination Other

Please explain in detail any periods of unemployment

Professional references

Reference 1 — name

Address

Phone number

Reference 2 — name

Address

Phone number

Reference 3 — name

Address

Phone number

Education

School and address · did you graduate? · diploma, degree or certification · dates attended.

High school

College

Nursing school

Aide training

CPR / First Aid — dates issued and expiration

Other

About you

Special skills and qualifications

Why are you interested in this position?

Any prior work experience that relates directly to the position you are applying for

Documents

Resume

Physical ID

First ID

Second ID

New Jersey home health aide license

We use the information in this application only to evaluate your candidacy. We never ask for your full Social Security number, bank details or any payment on a web form.

Exceptional, ethical, compassionate and professional home care services.

Coverage area

Passaic County
Essex County
Bergen County
Hudson County
Morris County
Sussex County

Get in touch

973-851-2519Phone info@pristinehhcs.comEmail

Office hours: Mon–Fri, 9:00 AM – 5:00 PM

Services
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© 2026 Pristine Home Health Care & Behavioral Services. All rights reserved.

Serving New Jersey.