Caregiver Priority Application

🎉Congrats! You've been invited to complete our priority application!

First Name *

Last Name *

Email 📧 *

Cell Phone Number 📱 *

Which best describes you? 🤔 * *

No caregiving experience but I am excited about starting a new career as a caregiver

Family caregiver who would like to help others

A Caregiver, HCA, or CNA with more than 6 months experience!

Drivers License 🚘🆔 * *

Yes, I have a current and valid driver's license

No, I do not have a drivers license at this time

Auto Insurance 💥🚗 * *

Yes I have auto insurance in my name

No, I do not have auto insurance at this time

Can you drive your vehicle to and from shifts? *

Yes, I have a car that is reliable!

No, I rely on other people, buses or lyft/uber to get around!

What day of the week and times are you available to work? *

Please briefly describe your caregiving experience. *

Have you worked for Visiting Angels before? *

Yes

No

Are you willing to do personal care, light housekeeping, and meal preparation? *

Yes

No

Many of our client's smoke or have animals. Are you willing to work in these homes? *

Yes

No

Showers: *

Partial Assist

Full Assist

Help in and out of shower/tub

Bed baths

Bed bound patient care experience: *

Yes

No

CRP? *

Yes

No

Food Handlers? *

Yes

No

Transfers: Are you familiar/comfortable performing transfers? *

Yes

No

Hoyer lift *

Yes

No

Sit-to-stand *

Yes

No

Gait Belt *

Yes

No

Offers of employment are contingent upon results of a thorough background check & drug screen.