Thank you for your interest in joining the HomeCare Family. Please take a moment to complete the caregiver questionnaire below.

Quick Caregiver Application

First Name *

Last Name *

Cell Phone Number 📱 *

Email 📧 *

City and State of residence *

Are you at least 18 Years Old? *

Yes

No

Are you eligible to work here in the US? *

Yes. I have supporting documents

No, but I'm working on my documents

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!

Which best describes you? *

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

Family caregiver who provided companionship and errands.

Family caregiver who provided care like toileting, bathing, and dressing.

A Caregiver, HHA, or CNA with more than 6 months experience.

How long have you worked as a professional caregiver? *

0-6 months

1-4 years

5-9 years

10+ years

What level of client care are you willing and able to provide? *

I am comfortable and willing to provide hands-on personal care, including bathing, dressing, toileting, incontinence care, and physical transfers.

I am only looking for light care, such as companionship, meal preparation, light housekeeping, and errands/transportation.

Which shift(s) are you available to work? MULTIPLE ANSWER *

Morning

Afternoon

Evening

Overnight

Are you available to work weekend shifts? *

Yes — I can work two full weekends per month (both Saturday and Sunday).

Yes — I can work one day every other weekend.

No — I cannot work weekends.

When are you available to start work? *

What is your desired hourly pay rate? *

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