Call Today for a FREE In-Home Care Assessment: Call (602) 264-8009

Apply for a Caring Career at Cypress HomeCare Solutions

Print a Paper Application

If you’d prefer to fill out a hard copy, you are more than welcome to stop by our office at 5225 N. Central Ave. Ste 212 Phoenix, AZ 85012 or call us at (602) 264-8009 to request a mailed copy.

Online Application

Once completed, the online application will be automatically delivered to us. Recommended: The online application works best in the Google Chrome browser.


Fillable PDF Application

Want to start the application now and finish later? Download the fillable PDF! Once completed, email the application to us at

All applicants need to be able to complete or provide the following prior to hire:

  • Three (3) references
  • Pre-Employment Drug Test
  • Pre-Employment Background Check
  • Valid Driver’s License
  • Current auto liability insurance
  • Current CPR & First Aid certification. *Must have skills done in person for valid submission. Online courses are not accepted unless on-site return demonstration of skills is available.
  • Negative Tuberculosis symptom results validating employee is free from symptoms of Tuberculosis with-in 1 year.
  • Valid Arizona Level 1 Fingerprint Clearance Card or application with the Department of Public Safety completed by date of hire.
  • Original I-9 documents verifying identity & eligibility to work in the U.S. will need to be shown within 3 business days of date of hire.
  • Ability to read, understand, write and speak English proficiently
  • Reliable transportation and communication devices (phone and email).


  • Applicant Personal Information
  • Employment
  • Work History

Applicant Personal Information

In compliance with our obligations under federal, state and local law, we consider applicants for all positions without regard to race, color, religion, creed, sex, gender, national origin, age, marital status, sexual orientation or identity, veteran status, mental or physical disability, or other legally protected status. If any accomodations need to be made due to disability during our pre-hire process, please notify Cypress HomeCare Solutions (which will be referred to throughout as the "Agency").

Employment, Referral, Training/Skills

How did you hear about this position?

Have you ever been employed by Cypress HomeCare Solutions before?

Are you 18 years of age or older?
Do you have any job related training or licenses? (Example: DCW, Certified Caregiver, C.N.A., etc.)

Do you have an Arizona Department of Public Safety Level 1 Fingerprint Clearance Card?


What type of work schedule are you looking for and where are you interested/available to work?

Hours Preference:



Preferred Work Area: (Please check all that apply).

South West:

Litchfield ParkTollesonAvondaleGoodyearBuckeye (S)Palo VerdeTonopah

North West:

PeoriaSun CityYoungtownEl MirageSun City WestSurpriseWittmanWickenburgBuckeye (N)


Phoenix (N)GlendaleParadise ValleyDeer ValleyAnthemNew River

Downtown/South Central:

LaveenPhoenix (Central)

North East:

Scottsdale (N)Cave CreekCarefreeRio VerdeFountain Hills

South East:

Scottsdale (S)TempeAhwatukeeChandlerSun LakesGilbertHigleyMesaApache JunctionSan Tan ValleyQueen Creek

Personal References

Please list the following information for three work references (co-workers, business associates, etc.) not related to you. These references should be in addition to the below current/former employers or supervisors. If not applicable, list three personal references not related to you.




Work Experience

Please list all employment for the past 7 years. Start with your most recent employment. Please complete even if you are submitting a resume. Attach additional sheets if necessary.


May we contact?

Dates of Employment:

Hourly Rate/Salary:


May we contact?

Dates of Employment:

Hourly Rate/Salary:


May we contact?

Dates of Employment:

Hourly Rate/Salary:

Employment Requirements:

Office of the Inspector General: Have you ever been excluded from participation in Medicare, Medicaid and/or other State or Federal health care programs?
I-9/E-Verify Information: If employment is pursued you will be required to produce original or certified documents and social security number verifying your identity and employment eligibility for reporting your earned wages. Are you able to provide verification of your identity within 3 days of hire?
Pre-Employment Criminal Background Check: Have you ever been convicted of a criminal offense by any court?
*Note: conviction will not necessarily disqualify you from employment consideration. The date, nature and circumstances will be considered in the relation of the position you are applying for.

If yes, was it a felony?

Attestation of Authenticity and Understanding:

Please read carefully and sign below: I verify that I have personally completed this application and the information reported in this application are true and correct to the best of my knowledge. I understand that any omission or misstatement of any information or documents related to my application and used to secure employment shall result in the rejection of my application or is grounds for immediate discharge if I am employed, regardless of the time of discovery. I hereby authorize the Agency to thoroughly investigate my references, current and previous work record, education and training records and other subjects related to my suitability for employment. I also authorize my listed references and previous employers to disclose information to the Agency and waive and release the reported references and employers from any and all claims, demands, or liabilities arising out of or in any way related to what are disclosed.