Toll-free: 1-877-295-2200
Personal Information

If you cannot be reached at above phone number, where may we contact you?

Answering yes to these questions does not constitute an automatic bar to employment.
Employment Desired

High School



Professional Education

Professional License/Certificates

Licence/Certificate 1

Licence/Certificate 2

Licence/Certificate 3

Personal References

Reference 1

Reference 2

Reference 3

Employment Record
List last or present position first

Position 1

Position 2

Position 3

Position 4

Position 5

Employment Understanding

This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, Vietnam era veteran status, or on the basis of age or physical or mental disability unrelated to ability to perform the work required.  No question on this application is intended to secure information to be used for such discrimination.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities including but not limited to reference checks, and criminal background checks , I agree to cooperate in such investigation and release from all liability or responsibility all persons, companies, or corporations supplying such information.  I Consent to take the physical examination, and such future physical examinations as may be required by this institution at such times and places as the institution shall designate.  I understand that an offer of employment may be contingent on passing the physical examination which relates to the essential duties I would be required to perform.

I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause.  I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

If employed, I will be required to complete an Employment Verification Form (I-9) and within three days show satisfactory evidence of identity and eligibility for employment.

I understand that Sunshine’s hiring process is a multistep process and I am not considered an employee until all the steps of the hiring process are successfully completed including signing the employee handbook.

If contacted for an interview, please provide the front desk with your driver’s license to copy

Additional Information

Please note if you are called in for an interview you will be asked to bring a copy of your TB and Physical at that time.

Do you have experience in the following: (Y/N)

Sunshine Work Policies

Weekend Work Requirements:
All Sunshine Home Health Care field staff are required to work, or be available to work, every other weekend.  This availability means the employee is available for shifts starting at Midnight on Friday night and going until 11:59 pm on Sunday night.

Client Assignments will be given based on employee skill set and client needs.  Each employee will be required to work a minimum average of 15 hours per week over a 2 month period.  If an employee does not maintain the required minimum work hours, he or she will be considered to voluntarily resign.  Employees may submit whether they prefer to work days, evenings, or overnight shifts.  Sunshine Home Health Care will try to adhere to these preferences, but due to the needs of the clients’ it may not always be possible.


If there are any changes in your physical capability, now or in the future, that limits your ability to perform the duties of your job you must notify the office verbally and in writing immediately.

I understand that emergency conditions may require schedule changes after signing my original schedule.  I understand that I will be notified of the schedule changes and will be required to work the new assignments upon notification.  I also understand that Sunshine requires all field staff to work at least every other weekend and on holidays.


Sunshine Criminal History and OIG Exclusion Policy

Indiana law prohibits employment of anyone by a license Home Health Agency or licensed Personal Service Agency, if that person’s limited criminal history, national criminal history background check, or expanded criminal history check indicates that the person has been convicted of any of the following:

(1) Rape (IC 35-42-4-1)
(2) Criminal deviate conduct (IC 35-42-4-2)
(3) Exploitation of an endangered adult ( IC 35-46-1-12)
(4) Failure to report battery, neglect, or exploitation of an endangered adult (IC 35-46-1-13)
(5) Theft (IC 35-43-4), if the conviction for theft occurred less than ten (10) years before the person’s employment application date
(6) A felony that is substantially equivalent to a felony listed IN:
(A) Subdivisions (1) through (4); or
(B) Subdivision (5), if the conviction for theft occurred less than ten (10) years before the person’s employment application date;
For which the conviction was entered in another state.

Sunshine is required to run every applicants name through the Office of Inspector General’s Exclusion list.  If you are on the exclusion list, Sunshine cannot offer you employment.