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In-Home Caregiver

PRESCREEN QUESTIONS

Are you legally authorized to work in this country? *

Yes

No

Can you pass a required background check?

Yes I will pass a state, federal, and FCSR screenings.

No, I will not pass all of the required screenings.

Are you at least 18 years of age? *

Yes

No

Do you have a VALID driver's license? *

Yes

No

Do you have auto insurance?

Yes

No

Do you have a smart phone and ability to know how to operate standard download mobile apps? *

Yes

No

Do you have a private reliable car to get back and forth to work in? *

Yes - I have my own car.

Yes - But I share my car.

No - I use public transport.

No - I get dropped off.

No - I will be walking.

What best describes your caregiving experience?

None, but willing to be trained!

I have experience caring for a family member.

I have professional experience as a caregiver.

I am a CNA or HHA (currently certified)

I am a CNA or HHA (not currently certified)

Please describe your experience RELATED to this role? *

How many years of caregiving experience?

0 - 6 months
6 months - 2 years
2 - 5 years
5 - 10 years
10+ years
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Is the RELATED experience within the last year? *

I don't have any.

Yes, currently still doing it.

Yes, it's within the past year.

No, it's more than a year ago.

This type of work can be tiring, are you able to stand, bend, kneel, twist and consistently lift 25 lbs throughout the day to perform the necessary duties in this role? *

Yes

Maybe

No

I want to work: (check all that apply)

Part-Time

Full-Time

Live-In

PRN (Occassionally/As-Needed)

What is your availability? (Check all that apply)

Weekdays

Weekends

Days

Evenings

Overnights

Live-In (2-5 days)

Please share details about your availability

CONTACT DETAILS

Full Name *

Email *

Phone *

Address *

City *

State *

Zip code *

By submitting this form, you agree to receive email and text alerts from us about the job you're applying for. This includes info about the application process, interview reminders, and job updates.

Additionally, you confirm that all the information provided in this application and during the upcoming interview is entirely true and accurate. You also understand that if anything is found to be false, the company can use at-will employment to end our association.

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