Contact and apply in one place.

The complete application form is kept together on this page so applicants can submit their details and documents without moving between different parts of the website.

Eight clear application sections Secure document uploads One complete submission

A caregiver in teal scrubs fastening her seat belt in a car

Complete applicationAll requested information in one form.

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Employment Application

Complete all applicable fields. Your information will be sent securely to the Diamond Affluence hiring team.

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1Basic Information

Full Name

Phone Number

Email Address

City / Town

Date of Birth

Position Applying For

CHHA CNA Companion Homemaker Live-In Other

Please specify the other position

2Credentials

CHHA / CNA / Companion

CHHA CNA Companion

License Number

CPR Certified?

Yes No

Uploaded documents are stored privately and are available only to authorized site administrators.

CHHA/CNA License Accepted files: PDF, JPG, or PNG. Maximum 5 MB per file.

CPR Card Accepted files: PDF, JPG, or PNG. Maximum 5 MB per file.

State ID Accepted files: PDF, JPG, or PNG. Maximum 5 MB per file.

4Experience Summary

Years of Experience

Last Employer

Specialties / Skills

5Emergency Contact

Name

Relationship

Phone Number

6Employment Eligibility

Are you legally eligible to work in the U.S.? (Optional)

Yes No

Do you have a valid driver's license?

Yes No

7References

Reference 1

Reference Name

Relationship

Phone Number

Reference 2

Reference Name

Relationship

Phone Number

8Consent & Signature

I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any false or misleading information may result in disqualification from employment or termination if discovered after hire.

I authorize Diamond Affluence Homecare Services to verify the information I have provided, including employment history, credentials, and references. I understand that this application does not guarantee employment and that any offer of work is contingent upon meeting all agency requirements.

By signing below, I acknowledge that I have read, understand, and agree to the terms stated above.

Digital Signature Type your full legal name.

Date