Caregiver Application

I, First Name * Last Name * , confirm that I have read the job description in full, and that - to my knowledge - I am capable of meeting ALL of the requirements and necessary job duties as listed in the description.

NameIf you go by a name other than your legal name, put it in quotes after your legal name (ex: Catherine "Kitty"). I will address you by the name in quotes.

First Name

Last Name

The position is paid for by In Home Support Services (IHSS) and Waiver Personal Care Services (WPCS). The wage is $20.33 an hour, and is non-negotiable, as the wage is determined by the state. By filling out this form, you acknowledge that this is the pay you will receive if hired. You also acknowledge that it may take a little under one month to over two months for the state programs to process your hiring, and that you will be paid in full for all the hours you worked before your paperwork is processed. You further agree to contact IHSS and WPCS directly for anything related to your paycheck, as Rian and their family have no control over the process beyond approving your time sheets.* This field is required.Indicate your understanding in the text box below:

Email* This field is required.Please leave your email so that I may contact you about your application.

example@example.com

Please indicate your remote interview preferences* This field is required.This is not a guarantee you'll get an interview. I'll reach out to schedule it if your application is accepted. Type in your phone number if you prefer to do the interview over phone than over Zoom.

Zoom

Other

At some point in the next couple of years, Rian wants to move out, either to Berkeley or Dublin.* This field is required.Will you be able to continue working with Rian as a client if they move to either of these locations? This will not impact any hiring decisions, but it is important to know for future reference, as building a new care team in a new city is difficult.

"I need to know why a task needs to be done in order for me to do it."* This field is required.Does this describe you?

YESNO

Have you been described as blunt or direct?* This field is required.Please give a yes or no answer, and provide a short example.

Rian is transgender and queer* This field is required.You don't need to understand their identity fully, and they will be patient with you if you forget their pronouns (they/them/themself). However, it is a core and obvious part of their identity. Which of the following describes you best? You may pick more than one.

Oh cool, I know someone like that!

Good for you! I'm fine with this

I don't see why this matters, but sure, that's fine

That makes me somewhat uncomfortable, but it won't be a problem

That's fine, as long as they don't shove it in my face or hit on me

That makes me very uncomfortable. I don't know if this will be a problem for me.

This is against my morals or religion, and I will feel discriminated against if they are open about their identity while I am on shift.

Other

You need to talk to Rian or check in with them, but they are in a room with the door closed.* This field is required.You will...

Open the door and get their attention

Knock and then open the door

Knock and wait for their permission to enter

Leave them alone and check in later

How do you handle...* This field is required.Rian tries to be independent, but sometimes they need assistance keeping things on schedule. What sort of strategies would you use to help Rian stay on track with their schedule?

How do you handle...* This field is required.Rian often runs out of breath while talking. They also tend to explain things in great detail, to ensure both the caregiver and themself are on the same page. If you know what they are talking about, do you:

Interrupt and move things along

Cut in to ask if they're describing something you already know

Ignore them and begin doing the task they're describing

Wait for them to finish and then begin the requested task

How do you handle...* This field is required.A majority of the time spent in this job is waiting. What do you do when you are waiting a long time (+2 hours) for a client to move to the next phase of the routine? How do you ensure your client can still get your attention when you are needed?

How do you handle...* This field is required.Rian's household has three cats and a dog. The dog is very excitable and affectionate, and one of their cats is a stubborn old lady with joint problems, who is not afraid to hiss, bite, or scratch if overly irritated. Please describe how you'd navigate a situation where these animals are impeding the task at hand. If you are allergic to cats and/or dogs, please say so here and work directly with Rian after the application is submitted to figure out if their home can be made a safe work environment for you.

Rian has a dog and three catsAre you willing to work in and will you be safe in a work environment with a dog and cats?

YESNO

How do you handle...* This field is required.Rian values their privacy greatly. They sometimes need help changing and showering, but had traumatic experiences with caregiver behavior while they are unclothed. To navigate this, you will:

Chide them for being so private, and encourage them to adapt to their reality

Help them every time without prompting to show they can trust you

Allow them the agency to say when they need help, follow their lead, and help brainstorm creative solutions

Empathize they're safe with you and take off your clothes to show there's nothing to be ashamed of

Rian needs assistance in meal prep and cooking* This field is required.Knowing how to cook is not required for the job, but being able to follow directions on how to cook is. Please address the following questions in your response: Do you like to cook? What sort of meals are you confident in making? Are you familiar with how to use a gas range stove? What practices do you employ to make sure the food you cook is safe to consume?

Optional: Upload a favorite picture saved to your camera rollThis can be an internet meme, a picture of your pets if you have any, a piece of art you saved, a photo of your favorite celebrity, etc. For safety and ethical reasons, DO NOT upload pictures of yourself or your family. I would like to avoid unconscious biases in the interview and hiring processes. This is for me to have an easy topic for small talk ahead of time.

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How do you handle...* This field is required.Imagine Rian needs your help to do something you disagree with, but what they want to do is relatively harmless. Do you help them accomplish their goal?

YESNO

How do you handle...* This field is required.Imagine Rian is on a restrictive diet for medical reasons. They will not be hospitalized if they break the diet, but they will experience digestive distress, such as cramps and abnormal bowel movements. They want to eat something that is against their diet, are fully aware of the consequences, and need help getting it. Do you get the food item for them?

YESNO

How do you handle...* This field is required.Rian's disability has symptoms of varying intensity over time. Because of this, their needs may change, sometimes from day to day, sometimes from month to month. Imagine after having a particular routine for a few weeks, they suddenly request you do one aspect differently. They say it's okay if it takes time to get used to, but you need to use the new method. Do you use the new method?

YESNO

How do you handle...* This field is required.Imagine Rian is in a sour mood. They are struggling to communicate effectively, and have a sharp tone of voice. They still attempt to be polite by saying "please" and "thank you," but it's clear they're frustrated, upset, or very tired. They may put in earplugs and demand the lights be turned down. What steps do you take to ensure their needs are still met effectively?

Rian currently lives with their parents* This field is required.Do you have experience serving a client who lived with family? Please describe that experience, with special attention to how you managed the client's needs versus the family's desires for the client. If you do not have experience, instead share what you would try to do.

Do you view caregiving as a profession or a calling?* This field is required.Please pick one. I will ask for your reasoning if we do an interview. There is no wrong answer for this question.

ProfessionCalling

Which of the following describes you?* This field is required.You may pick as many options as you'd like

You can tell me what to do once and I've got it down from there

I don't like being told what to do

I need specific directions to do my best, including with routines I'm familiar with

I appreciate directions, but I can memorize the routine and do the next steps proactively, as needed

I feel like I'm being interrupted when I'm informed of the next task in the middle of the current task

I ask clarifying questions as they occur to me

I prefer it when my client doesn't need to tell me what to do - I'd rather just get the job done

I like to make suggestions to improve my client's routine and methods

I dedicate the first shifts to learning the current routine and methods

When a client self-directs their care frequently, I feel disrespected

I can learn new ways of completing a task on short notice

This job requires operation of heavy machinery, regardless of shift time.* This field is required.Are you confident in your ability to operate heavy machinery safely for the hours you have in mind? Will you practice basic safety measures for heavy machinery while on shift? If "no" to any of these, please click NO.

YESNO

Closed toed shoes* are a requirement in this job* This field is required.*NOT slippers, sandals, or crocs, as they have historically been ineffective at protecting toes

I understand; I will have closed toed shoes by the time I start, if selected

I do not understand; I will wear what I want

Have you had an up to date COVID, flu & measles vaccine?* This field is required.You will be expected to provide medical documentation of these vaccines during the in-person interview if accepted. This question is a text box so that you may provide any pertinent details regarding your vaccination status. If you have one but not others, please say so. Masks will be required while in the home if you are working while waiting to receive the vaccine(s).

Have you had an up to date COVID & flu vaccine?You will be expected to provide medical documentation of these vaccines during the interview if accepted.

YESNO

Do you smoke or vape?* This field is required.You will NOT be provided smoke breaks.

YESNO

Smoking or vaping will not be tolerated while on shift. Do you agree to follow this rule?* This field is required.This means no smoke breaks either, as our property is smoke-free.

YESNO

Day shifts require the ability to drive Rian's wheelchair-accessible van.* This field is required.Please confirm whether you have a valid, up-to-date driver's license. Please also confirm whether you will submit to a driving background check. Describe your familiarity with wheelchair-accessible vans and yourself as a driver. You may write "N/A" if you will not be doing daytime shifts.

Which shifts are you interested in?* This field is required.Please only select shifts you are actually available for. I will contact you to arrange specific shift times if we move forward with the hiring process. Generally speaking, mornings go from around 8 or 9 am to 12 or 1 pm, afternoons from around 1 to 4 or 5, and evenings from around 8 pm to 1 am (the specific end times vary from day to day, so a certain level of flexibility is required). Overnight shifts can be anywhere from 8 pm to 8 am, to 10 to 10. You must agree to at least two shifts per week, on separate days. The following shifts are taken: 9 am to 4 pm, Monday - Friday 7:30 pm to 7:30 am, Monday - Wednesday Generally speaking, you will not be considered for replacing currently taken shifts, but you may be considered as an on-call backup. Currently, Friday 8:30 pm to 8:30 am needs a backup who will become a replacement sometime next year.

Some or all weekdays (morning)

Some or all weekdays (afternoon)

Some or all weekdays (evening)

Some or all weekday overnights

Weekends (morning)

Weekends (afternoon)

Weekends (evening)

Weekends overnights

If you have a resume, you may submit it hereIf you don't have a resume, that's fine - please offer at least two reference contacts (see the next question). Do NOT put ID cards or legal documentation here.

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References* This field is required.Please put any references you have here, regardless of if you submitted a resume. If you do not have a resume, please put at least two references. They may be personal references if no professional ones are available. If entering a phone number, specify whether you know if text is available for the number. Due to the nature of this position, references are required.

Optional: Is there anything you'd like to add about yourself as an employee that you feel is not reflected in this application?Please DO NOT leave information about your living circumstances, health, relationships, or family.

Caregiver Application