Today's Date: *

First Name *

Last Name *

Phone *

Email *

The zip code that I live in: *

Are you authorized to work in the U.S.? *

How did you hear about Senior Helpers? *

Have you applied or worked for this Senior Helpers location before? *

Yes

I can't remember

Which area/s would you like to work in? *

Available start date: *

IMPORTANT: Fill in the hours you can work.👇🏼

Example schedule:
Monday, 8 am - 5 pm
Tuesday - DNS (do not schedule)
Wednesday, 10 am - 4 pm
Thursday - DNS
Friday - DNS
Saturday - 10 pm - 7 am
Sunday -DNS

We use these hours to build your schedule in our system.

What hours can you work? *

Are you available to work weekends? *

Are you available to work nights? *

Are you currently employed? *

Are you willing to drive at least 30 miles to a client's house? *

Yes

Are you able and willing to lift up to 30 lbs. and push or pull up to 50 lbs.? *

Are you comfortable bathing a female client? *

Yes

Are you comfortable bathing a male client? *

Yes

Are you able to work around dogs? *

Yes

Are you able to work around cats? *

Yes

Are you a smoker? *

Yes

If you are a smoker, are you able to complete your shift without a smoke break?

Yes

Depends on length of shift

If you are NOT a smoker, are you willing to work with a client who smokes?

Yes

Do you have any of the following certifications?

How much caregiving experience do you have - either private, facility, or agency? *

Do you have a car? *

Do you currently hold a valid driver's license? *

Do you currently have car insurance in your name? *

Have you had any moving violations or accidents during the past three years? *

Is your vehicle clean and in good condition? *

Yes

Usually. But I'll make it happen before I start!

Are you able to pass a background check? *

Yes

Unsure

I can explain

Are you able to pass a drug test? *

Yes

Unsure

I can explain

By checking this box, you consent to receive SMS messages and email communications from Senior Helpers regarding job opportunities and updates. Msg & data rates may apply.