Caregiver Application
Job Description: We are looking for CNAs and caregivers who are kind, respectful, and detail-oriented. You must have reliable transportation, a high school diploma or a GED, and willing to undergo a background test. The pay is $13.50 - $14.00 an hour. This is a part-time position. This position includes caring and providing personal care to our clients, light housekeeping, and assisting with activities of daily living.
Name
First Name
Middle Name
Last Name
Phone Number
-
Area Code
Phone Number
Professional e-mail address
example@example.com
Total number of years working as a caregiver:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I meet the following requirements (check all that apply):
Passion for helping the elderly
Professional Outlook
Knowledgeable about Alzheimer's and Dementia
Reliable & prompt
Able to commit to job timeline
18 years old +
Safe & reliable transportation
Non-smoker
Can legally work in the U.S.
Current CPR/BLS certification or willingness to renew
Do you have any disabilities?
Yes
No
Other
Are you authorized to work in the United States?
Yes
No
Are you able to work Monday - Friday 2 pm - 8 pm?
Yes
No
Do you have reliable transportation?
Yes
No
Do you have a driver's license?
Yes
No
Do you have a high school diploma or GED?
Please Select
Yes
No
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Date You Can Start
-
Month
-
Day
Year
Date Picker Icon
Salary Desired
Position Interested In (check all that apply):
Full Time
Part Time
Temporary
On Call
Experienced With:
Multiples
Special Needs
Allergies
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Skills/Qualifications:
What skills and experience do you have that are useful for caregiving? Feel free to be as in depth as possible.
CPR/First Aid Certified?
Please Select
Yes
No
Willing to Get Certified
CPR/First Aid Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
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Education:
Highest Level of Education:
Please Select
High School
College
Graduate School
High School
Name of High School Attended
Graduated High School?
Please Select
Yes
No
College
Name of College/University Attended
Graduated College?
Please Select
Yes
No
Number of Years Attended College
College Area of Study/Degree
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Cover Letter & Resume:
Please Upload Your Cover Letter
Upload a File
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Please Upload Your Resume
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Acknowledgement
I have uploaded my resume. Without a resume, I understand that my application may not be considered.
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