Home Care Services in Northern Virginia

Have a rewarding and meaningful career in the health care industry today! We at Elyon Home HealthCare is currently looking for healthcare professionals who are licensed, experienced, skilled, and passionate about delivering high-quality care to diverse individuals. If you think you deserve to be a part of our team of care experts, then you may fill out the form below for an initial application. We will contact you once we finish reviewing your application.

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Name *

First

Last

Address *

Address Line 1

City

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Zip Code

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Email

Gender *

Phone

SSN

Date of Birth *

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Emergency Contact

Phone

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Do you have current First Aid Certification? (State Level) *

• Yes
• No

First Aid Certification Expiry Date

Enter expiry date for your certification with date format (mm/dd/yy). Example; 12/05/2025

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Do you have current CPR Certification? (State Level) *

• Yes
• No

CPR Certification Expiry Date

Enter expiry date for your certification with date format (mm/dd/yy). Example; 12/05/2025

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Certificate/License

Expiry Date

Enter expiry date with date format (mm/dd/yy). Example; 12/05/2025

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Type of Position(s) Preferred *RNLPNCNA/PCA/HHAOther

Experience

Attachment

Click or drag files to this area to upload. You can upload up to 3 files.

Attachment: CPR Certificate, License/Certificate if appplicable, PPD/TB Test Results

SWORN STATEMENT

Section 63.2-1720 of the Code of Virginia requires that any person desiring to work at ELYON HOME HEALTHCARE shall provide the Agency with a sworn statement or affirmation disclosing any criminal convictions or pending criminal charges, whether within or outside the Commonwealth of Virginia. The law prohibits licensed Home Care Organizations from hiring or continuing to employ any individuals convicted of a barrier crime. However, applicants convicted of one misdemeanor barrier crime not involving abuse or neglect may be hired or continue to be employed if five years have elapsed since the conviction. Any person making a materially false statement on this form regarding any criminal offense shall be guilty of a Class I misdemeanor. Further dissemination of the background check information provided on this form is prohibited other than to the Commissioner's representative or a federal or state authority or court as may be required to comply with an express requirement of law for such further dissemination

Have you ever been convicted of a law violation(s) but excluding offenses committed before your eighteenth birthday that were finally adjudicated in a juvenile court or under a youth offender law? *

• Yes
• No

If "Yes", list all and explain

Are you the subject of any pending criminal charges? *

• Yes
• No

If "Yes", explain

AFFIRMATION

I certify that, to the best of my knowledge, the answers given are true and complete and that purposeful misrepresentation may result in rejection of my application. I authorize investigation of all statements contained in this application, as required. Additionally, I authorize former employers, references and any other individual/organizations to provide information to Elyon Home HealthCare and I hereby release and discharge any of the above and Elyon Home HealthCare from any liability of any kind or nature. I also understand that it is my responsibility to keep such information current and accurate by updating it as often as necessary I understand that failure to meet any medical and/or health requirements for the position may prevent my employment with the Agency. I also understand that employment, for certain positions, may be conditional upon successful completion of a substance abuse screening test and a criminal background check I further understand that, if hired, I may be required to provide proof that I am a citizen of the United States or proof that I am currently authorized to work in the United States

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Applicant's Signature *

Clear Signature

Date *

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