New Hires

Welcome to the new hires page. On this page we will ask you to enter basic necessary information for you to get started working with us. Please fill out the form below.

Apply Online

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Your first name
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Your last name
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Street Address
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City
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State
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Zip Code
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Home phone number
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Mobile phone number
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Briefly tell us your availability
Enter the full name for emergency contact
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Phone number for emergency contact
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Emergency contact relationship
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Home Care Aide Number ( If you have )
Home Care Aide Issue Date ( If you have )
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Reference Company
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Reference Company Relationship
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Reference Company Phone Number
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Reference Company Email
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Reference Company2
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Reference Company2 Relationship
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Reference Company2 Phone
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Reference Company 2 Email
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Social Security Number ( No dashes or spaces )
Social Security Number Image ( jpg, jpeg ONLY )
Choose 1 Proof of work status
Upload image of your work status ( .jpg, .jpeg ONLY )
Upload your Drivers License picture (.jpg, .jpeg ONLY )
Upload your auto insurance picture (.jpg, .jpeg ONLY )
.jpg, .jpeg, pdf ONLY

Fields with (*) are compulsory.

Thank you for completing the form. For official documents, please fill out the 6 forms below and send the finished documents as electrically, scan,
and screenshot to info@hollyservices.com

  1.  FORM W-4 https://www.irs.gov/pub/irs-pdf/fw4.pdf
  2.  FORM DE4 https://www.edd.ca.gov/pdf_pub_ctr/de4.pdf
  3.  FORM I-9 https://www.uscis.gov/sites/default/files/document/forms/i-9-paper-version.pdf
  4.  HCS 501 Personnel Record https://www.cdss.ca.gov/cdssweb/entres/forms/English/HCS501.pdf
  5. LIC 508 (Criminal Record) https://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC508.PDF
  6. SOC 341A (Elderly Abuse) https://cdss.ca.gov/cdssweb/entres/forms/English/SOC341A.pdf