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Quality Customized Care

WANT TO BE A CONTRACTOR OR EMPLOYEE?

Interested in becoming a contractor? Join the team of professionals at Affordable Care Services and Enterprises LLC in Atlanta, GA.

Application Process

Jumpstart your life by providing customized support services. Apply now, and be one of our professionals. Simply download our application form(s) and required document list below. Once completed, send it back to us along with all required documentation at:

info@affordablecse.com, fax it to 678-805-4627, or to our address 925 Main St Suite 106 Stone Mountain GA 30083.

Required Document ListRequired Document List

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CONTRACTOR APPLICATION

To Download the "Contractor Application" follow these instructions:

Contractor Application Form

1. Download the form to your computer

2. Fill it all out

3. Go back to the website

4. Click on the upload/browse button and attach form

5. Then hit submit

Invalid Form properties detected

Please enter information...

Invalid Form properties detected

Please print clearly. Do not leave any blank spaces.

Name (last, first)

Please enter information...

Date of Birth

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Application Date

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Mailing Address

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City

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State

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Zip Code

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Home Phone #

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Cell Phone #

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Other Phone #

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Email Address

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Desired Start Date

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Are you over 18?

Please check...Yes Please check...No

How did you hear about A. C. S & E?

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Have you ever worked for A. C. S & E.

Please check...Yes Please check...No

Emergency Contact Name

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Relationship

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Home Phone #

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Cell Phone #

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Emergency Contact Name

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Relationship

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Home Phone #

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Cell Phone #

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1. {For Family Supported Living Only} Do you own or rent your home

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2. Do you have the legal right to work in the United States for any employers?

Please check...Yes Please check...No

3. Have you been convicted for any violations of the law?

Please check...Yes Please check...No

4. Have you been convicted of a misdemeanor or felony?

Please check...Yes Please check...No

5. Are there any pending charges against you?

Please check...Yes Please check...No

If you answered “Yes” to any of the 3 questions above, please explain:

Please enter information...

A conviction will not necessarily prevent you from being hired. However, failure to disclose a conviction or a pending conviction is

called, “Non-Disclosure.” “Non-Disclosure” will prevent you from being considered for employment

EDUCATION AND TRAINING

High School

Name & Location

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Course of Study

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Years Attended

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Degree/Certificate

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Vocational

Name & Location

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Course of Study

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Years Attended

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Degree/Certificate

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College

Name & Location

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Course of Study

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Years Attended

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Degree/Certificate

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Other

Name & Location

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Course of Study

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Years Attended

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Degree/Certificate

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Please list any special skills and/or trainings you have had that will help you perform in this line of work:

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Why do you want to work for Affordable Care Services & Enterprises, LLC?

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SKILLS ASSESSMENT

If you have questions about the following home care duties, please ask one of our Agency Managers for more information.

Are you able and/or willing to perform these home care tasks/duties?

Ambulation

Please check...Yes Please check...No

Assistance w/ Travel

Please check...Yes Please check...No

Bathing

Please check...Yes Please check...No

Body Care

Please check...Yes Please check...No

Dressing

Please check...Yes Please check...No

Eating (assistance w/ eating)

Please check...Yes Please check...No

Grooming

Please check...Yes Please check...No

Housework

Please check...Yes Please check...No

Laundry

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Meal Planning/Diets

Please check...Yes Please check...No

Diaper Change

Please check...Yes Please check...No

Meal Preparation

Please check...Yes Please check...No

Medication Reminders

Please check...Yes Please check...No

Personal Hygiene

Please check...Yes Please check...No

Positioning

Please check...Yes Please check...No

Shopping/Errands

Please check...Yes Please check...No

Supervision

Please check...Yes Please check...No

Toileting

Please check...Yes Please check...No

Transferring

Please check...Yes Please check...No

Telephone Assistance

Please check...Yes Please check...No

Companionship

Please check...Yes Please check...No

Community Integration

Please check...Yes Please check...No

Please explain any experiences that you have had with individuals who have disabilities:

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EMPLOYMENT HISTORY

Employer (present or most recent)

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Telephone

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Address

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Position

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Supervisor

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Reason for Leaving

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Dates of Employment

From & To

Starting Salary

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Final Salary

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May we contact this employer?

Please check...Yes Please check...No

Describe your duties (It is important to be specific and thorough.)

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Employer (previous)

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Telephone

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Address

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Position

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Supervisor

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Reason for Leaving

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Dates of Employment

From & To

Starting Salary

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Final Salary

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May we contact this employer?

Please check...Yes Please check...No

Describe your duties (It is important to be specific and thorough.)

Please enter information...

Employer (previous)

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Telephone

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Address

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Position

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Supervisor

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Reason for Leaving

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Dates of Employment

From & To

Starting Salary

Please enter information...

Final Salary

Please enter information...

May we contact this employer?

Please check...Yes Please check...No

Describe your duties (It is important to be specific and thorough.)

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ADDITIONAL INFORMATION

What qualifications and skills make you a good candidate for this position?

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I certify that the information provided by me in this application is complete, truthful, an accurate to the best of my knowledge. I

understand and agree that my failure to provide complete, truthful and accurate information on this application may result in denial of

employment, or, if already employed, immediate termination. I understand that my continuous employment may be contingent upon

passing for illegal drugs, a health review physical, proof of employment eligibility and/or reference and criminal background check. I

authorize Affordable Care Services & Enterprises, LLC and its personnel to contact any and all references I have listed

on this application for relevant information and release all such persons from all claims, liabilities and damages for whatever reason

arising out of furnishing said information. If I am employed, I agree to conform to the rules and regulations of Affordable Care

Services & Enterprises, LLC I understand that Affordable Care Services & Enterprises, LLC is an Equal Opportunity Employer and

that all applicants will receive consideration for employment without regard to race, religion, political affiliation, color, gender, age,

national origin, disability, marital status, or veteran status

Name (print)

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Signature

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Date

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Employee Application Form

To Download the "Employee Application Form" follow these instructions:

Employee Application Form

1. Download the form to your computer

2. Fill it all out

3. Go back to the website

4. Click on the upload/browse button and attach form

5. Then hit submit

Invalid Form properties detected

Please enter information...

Contact our company with any questions or information needed

Affordable Care Services and Enterprises LLC is known for providing quality customized support services, whether you want to be part of our long list of licensed professionals or join our independent contracting team, don’t hesitate to let us know. Our rigorous screening and application process help us become the preferred service provider in the metro Atlanta and surrounding areas. Contact us today for more details.

Helper In Residential Home Giving Food To Senior Man

Group Of People Holding The JOIN OUR TEAM

Affordable Care Services and Enterprises LLC

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925 Main St Suite 106

Stone Mountain GA 30083

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Local: 404-405-4571

Toll-Free:

800-299-5670

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info@affordablecse.com

We offer our services in English, Spanish and American Sign Language.