Home About Us Giving Careers Contact Us Clarity Care Connection Facebook LinkedIn

Apply Online

Work at Clarity Care

We are excited you are interested in applying for a position with Clarity Care.


It's easy to apply online. To begin, select the positions for which you are applying, using our secure form below. If at any time you have questions while completing the form, please contact us.


* fields are required


Job Selection


* Select the position for which you are applying.

* How did you hear about this position?

Personal Profile


* First Name Middle Initial
* Last Name
* Street Address * City
* State/Province * Zip/Postal Code
Cell Phone  (###)###-####   Primary Secondary
Home Phone  (###)###-####   Primary Secondary
Best way to reach me Phone  Text  E-mail
Best time to reach me
Times I am available for an interview

* Are you 18 or older?      Yes No
Have you ever been employed with Clarity Care before?      Yes No
Type of employment desired.      Full-time Part-time Either
* Have you been convicted of a felony or misdemeanor in the last seven years?      Yes No
If yes, please state date, place and nature of convictions.     
* Do you have a valid drivers license?      Yes No
Drivers license number     
Do you have auto insurance?      Yes No
Do you have a reliable vehicle?      Yes No
If no, how would you get to work?.     
* Are you applying to care for a family member or a personal friend through Clarity Care’s Family and Friends program?      Yes No
* What shifts are you available to work?      First Second Third Any
* Are you available to work two weekends per month?      Yes No
* What county are you most interested in working?     

Employment Information


Starting with your most recent, please list your last three (3) employers, military experience, or volunteer activities.


No employment history


* Employer 1     
Street, City, State & Zip     
* Job Title     
* Immediate Supervisor     
* Supervisor Title     
* Reason for leaving     
* May we contact for reference      Yes No
* Dates employed from      to        (mm/dd/yyyy)
Hourly rate/ Salary starting   $ Per    
Ending   $ Per    
Employer 2     
Street, City, State & Zip     
Job Title     
Immediate Supervisor     
Supervisor Title     
Reason for leaving     
May we contact for reference      Yes No
Dates employed from      to        (mm/dd/yyyy)
Hourly rate/ Salary Starting   $ Per    
Ending   $ Per    
Employer 3     
Street, City, State & Zip     
Job Title     
Immediate Supervisor     
Supervisor Title     
Reason for leaving     
May we contact for reference      Yes No
Dates employed from      to        (mm/dd/yyyy)
Hourly rate/ Salary Starting   $ Per    
Ending   $ Per    

Educational Background


* Starting with high school, please list your educational background (input at least one).


Name of SchoolGraduated? Y/NDegree/DiplomaMajor/Type

Professional/Trade Certification or Licenses
Certification/LicenseDate (mm/dd/yyyy)Issued By

Additional Information


       * List 2 business references and 1 personal or school reference who are not relatives.
     Reference NameYearsEmailPhoneRelationship

Employee Responsibility to the Organization


Please be sure to read the following statements carefully.


I certify that all the information I have provided on this application is true and complete to the best of my knowledge. I understand that omitting requested information or giving false information on my application in my interview (s) or in the process of my pre-employment evaluation may result in rejection of my application, withdrawal of a job offer, or termination, if I am hired.


I authorize investigation of all statements in this application as may be necessary in arriving at an employment decision, including a police/criminal record check from the Wisconsin Department of Justice or any other appropriate Agency(s). I hereby release from liability the employer(s) and its representatives for seeking and furnishing such information.


I understand that if offered a job, I will be required to:

  1. Undergo a physical health exam, TB test, and communicable disease screening by a physician designated by the Employer, which may affect decisions whether I can do the essential functions of the job.
  2. Undergo and pass a criminal record, driving record and reference checks
  3. And, after placement, complete and receive certification in any and all employee training required and requested by the Employer. I understand this training needs to be competed within the first 90 days of employment and is a condition for continued employment.

I understand that the organization is an equal opportunity employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on any basis prohibited by local, state or federal law.


I understand that this application does not represent an offer of, or contract for, employment. I understand that employment with this company is "at will," and that no guarantee of a job exists. If employed, I may terminate employment at any time for any reason, and the company may terminate my employment at any time for any reason not contrary to law.


This application is current for only (60) days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to fill out a new application.


* I have read and agreed to the above statement.


Voluntary Information


Complete Voluntary Form

Resume Upload


Upload a resume (optional)    

Accepted file types are Microsoft Word, Works, OpenDocument, Plain Text, RTF, PDF.