Visiting Angels - Largo/Prince George County is hiring: MyCNA Jobs Marketplace i

Application Form Content

• I would like to communicate with the hiring team via text message about my application and next steps.
• Address (required)
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• State/Province
• Were you referred by anyone?
• Were you referred by anyone? Yes No
• Please add your resume
• 10MB limit; .pdf, .doc, and .docx file types are accepted.
• What is your earliest available start date?
• Work History
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• Job title held (required)
• End date
• Current
• Did you manage others in this role?
• If yes, please explain
• What did you like most about the position?
• What did you like least about this position and why did you leave (or plan to leave)?
• Education
• Highest level of education completed
• Military Experience
• Did you serve in any branch of the US Armed Services?
• Did you serve in any branch of the US Armed Services? Yes No
• Other Information
• Do you have an active Maryland CNA, CMT or GNA License?
• Please enter your License type and license number.
• Do you work better independently or as a part of a team? Why
• What value would you add to this organization? (Talk about past valued experiences)
• What is the most important thing you are looking for in a job and WHY? (ex. flexibility, location)
• Do you have a legal right to work for any employer in the United States?
• Select

Equal Employment Opportunity Information (Voluntary Disclosures)

Visiting Angels - Largo/Prince George County is proud to be an Equal Employment Opportunity and Affirmative Action employer. All employment decisions at Visiting Angels - Largo/Prince George County are based on business needs, job requirements and individual qualifications, without regard to an applicant’s race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, past or present military service, or any other characteristic protected by law. The purpose of this Self-Identification Form is to comply with federal government record-keeping and reporting requirements, and to ensure equal employment opportunity at Visiting Angels - Largo/Prince George County. The data you provide on this form will be kept confidential and used solely for analytical and reporting requirement purposes. When reported, data will not identify any specific individuals. Moreover, this information will be kept separate from your application.

Answering these questions is optional and voluntary and your refusal to provide it will not subject you to any adverse treatment.

Are you Hispanic or Latino?

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Ethnic and Race identification

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

Visiting Angels - Largo/Prince George County is subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1975, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Visiting Angels - Largo/Prince George County to take affirmative action to employ and advance in employment veterans in the following classifications.

A “disabled veteran” is one of the following: A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs or a person who was discharged or released from active duty because of a service-connected disability.

A “recently-separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.

An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As an employer subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with VEVRAA.

Form CC-305

OMB Control Number 1250-0005

Expires 4/30/2026

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp .

How do I know if I have a disability?A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability.

Disabilities include, but are not limited to:

• Alcohol or other substance use disorder (not currently using drugs illegally)
• Blind or low vision
• Cancer (past or present)
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or serious difficulty hearing
• Depression or anxiety
• Diabetes
• Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
• Epilepsy or other seizure disorder
• Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
• Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
• Missing limbs or partially missing limbs
• Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
• Nervous system condition, for example, migraine headaches, Parkinson's disease, Multiple sclerosis (MS)
• Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema

Disability Status

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

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Date: 9/28/2025

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