First Name
*
Last Name
*
Phone
*
Email
*
Are you from California
*
Yes
No
City
*
What made you choose to apply to be a caregiver?
*
Do you have experience in Caregiving?
*
Yes
No
I agree to
terms & conditions
provided by the company. By providing my phone number, I agree to receive text messages from the business.
Do you have experience working for 1-on-1 clients in Home Care?
*
Yes
No
Do you have experience caring for the elderly (Personal experience is counted)?
*
Yes
No
Do you have experience working in a facility?
Yes
No
Are you vaccinated?
*
Yes with Booster
1st and 2nd Dose only
No I am not vaccinated
Do you drive your own car? Are you comfortable driving clients to their errands?
*
Yes
No
Are you willing to drive at least 20 miles to your client’s home?
*
Yes
No
Our clients depend and count on you! Most cannot go a day without personal care. Are you reliable and punctual?
*
Yes
No
Are you willing to help cover shifts, when your team member calls out due to an emergency? Are you a team player?
*
Yes
No
Many or our clients require 24/7 care, which means they need weekend care. Are okay with 1 weekend shift per month?
*
Yes
No
What days will you be available?
7 Days out of the week
Mon - Fri
Weekends only
Anytime
These are state mandated requirements, Do you have or willing to obtain the following clearances:
Live Scan Fingerprints, and be part of the Home Care Aide registry?
*
Yes, I am registered already
No, I am not registered, but willing
Tuberculosis Test?
*
Yes, I have it already
No, but I am willing to get the test
CPR/First Aide Certificate?
*
I have it ready
I am willing to get it