• CAREGIVER CONTRACTOR APPLICATION

    CAREGIVER CONTRACTOR APPLICATION

  • I acknowledge and accept that my role will be as an independent contractor, not as an employee of the company.*
  • What level of self-employment are you applying for?*

  • PLEASE EXIT THE FORM. YOU DO NOT QUALIFY AS A POTENTIAL CAREGIVER.

  • In compliance with Florida Law Title XXXI, 435.03 we conduct a comprehensive background screening. Have you EVER been charged or convicted of ANY criminal offense?*

  • Be Ready to complete the Registration

    To expedite your registration process, please ensure you have the following documents and information readily available:

    • Driver’s License
    • Social Security Card
    • Proof of Car Insurance

  • Personal Information:

  • Format: (000) 000-0000.
  • Is this a Smart Phone?*
  • Date of Birth*
     - -
  • Are You a U.S. Citizen?*

  • Job Description

    Read Carefully before applying
  • Caregivers support clients in their daily tasks. What specific activities are you available to assist clients with? (Select all that apply)*

  • Suitability

    How would you fit into our culture
  •
  • Have you had experience cooking for other people?*
  • Would you be able to transfer someone from a wheelchair into a car or into a bed?*
  • Do you have a car?*

  • Availability:

    You are registering as a personal care sitter
  • When can you start*
     - -
  • How many hours per week would you like to work?
  • We have several clients that require 24/7 care. Are you able to work over night?*
  • Rows
  • Have you registered with us before?*
  • Preferred Work Radius from Home*

  • Education:

  • Did you graduate High School?*
  • Did you get your GED?*

  • Skills/Qualifications:

    What skills do you have that will help you as a caregiver?
  • Have you ever worked as an ADULT Caregiver, sitter or companion for someone other than a family member?*

  • Current Employment:

    Please provide the last 5 years of work experience
  • Are you currently employed?*
  • May we contact your current employer?*

  • Previous Employment:

  • Work References:

    We'll send a verification form via email to your references. They will have 3 days to complete the form. Please inform them to expect the email.

  • Background Check Information

  • As part of our dedication to ensuring the best for our clients, it is our responsibility to conduct a thorough background check. This process encompasses both a criminal background check and reaching out to your provided references. Initially, we will attempt to contact your references via email, so it may be beneficial for you to inform them beforehand. Should we not receive a response via email, we will proceed with a phone call. We eagerly anticipate welcoming you to the COMPANY NAME community.

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  • Additional information:

    This information is optional.
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  • Send Application:

  • By clicking the submit button below, I confirm that all information provided in this questionnaire is honest and complete. I understand that providing false information, omitting details, or misrepresenting facts may lead to the rejection of my registration. In joining, I agree to follow the company's rules and regulations. I acknowledge that my registration and Bio may be terminated, with or without cause, and with or without notice, at any time, either at my discretion or at the company's. I also understand that the company reserves the right to change the terms and conditions of my registration, with or without cause, and with or without notice, at any time.

  • Today's Date
     - -
  • Reload

  • We host open interviews every Thursday from 10 AM to 4 PM. Please choose a time that works for you to attend. The interviews will take place at Neon's Bar 72, located at 4701 Bay Point Rd, Panama City Beach, FL 32408. 

    When you arrive at Neon's Bar 72 - you will go into a gate that looks like you are entering a golf course. You will tell the attendant that you are going to Neon's Bar 72 and they will give you a parking pass to get in (it is free)!

  • Appointment*
  • Should be Empty: