Bella Mente — Care with kindness

Employment Application

Join our team — care with kindness. All fields help us find the right fit; sections 6–7 are optional but appreciated.

Equal opportunity & your privacy
Bella Mente, Inc. is an equal opportunity employer. Consistent with Minnesota law (Minn. Stat. §364.021), this application does not ask about criminal history; direct-care employment is conditioned on a Minnesota DHS background study (Minn. Stat. ch. 245C) after a conditional offer. If you need an accommodation to complete this application, contact our office.

1. Applicant Information

Are you legally authorized to work in the United States?
Are you 18 years of age or older?
Do you have a valid driver’s license and reliable transportation?
Have you served in the U.S. military?

2. Employment History

Start with your current or most recent employer.

Employer 1 (current or most recent)

May we contact this employer?

Employer 2

May we contact this employer?

Employer 3

May we contact this employer?

3. Education & Training

High school

College / university

Trade or technical school

Other

4. Availability

List the hours you are available each day (e.g., 8am–2pm; overnight).

5. References

Reference 1 (professional)

Reference 2 (professional)

Reference 3 (personal or professional)

6. Service Preferences

Which services are you interested in providing? (check all that apply)
Comfortable working with persons or homes that include: (check all that apply)
Transportation available:
Any allergies that could affect working in a client’s home?

7. Required Training & Certifications

CareCertify training — required and paid (245D positions)
All staff providing 245D services must complete Bella Mente’s required orientation and annual training, delivered through CareCertify, before providing direct support (Minn. Stat. §245D.09, subds. 4–4a). You do NOT need this before applying — it is provided after hire, and this mandatory training time is paid work time at no less than the 2026 Minnesota minimum wage of $11.41/hour.
Do you currently hold a DHS Individual PCA / CFSS training certificate?

The DHS individual PCA/CFSS course and test are free at registrationcourses.dhs.state.mn.us. If you already have your certificate, upload a photo or screenshot of it below.

DHS PCA / CFSS training certificate (upload if you have one)
Other relevant training certificate — CPR, First Aid, CNA, med administration, etc. (optional)

8. Direct-Care Experience (PCA / CFSS applicants)

Do you have experience as a PCA / CFSS worker or caregiver?
Comfortable assisting clients with bathroom / toileting needs?
Comfortable assisting with a range-of-motion program?
Comfortable assisting with a bowel program?

9. Certification & Signature

I certify that the information on this application is true and complete to the best of my knowledge. I understand that falsified or omitted information may disqualify me from consideration or result in dismissal if hired. I authorize Bella Mente, Inc. to contact the employers I have approved above and my listed references regarding my work record. I understand that any offer of employment for a direct-care position is conditioned on the satisfactory completion of a Minnesota DHS background study under Minn. Stat. ch. 245C, and that employment is at-will.

Applicant signature