Form
Carelink Services – Caregiver Application
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Application
-
Month
-
Day
Year
Date
How many years of caregiving experience do you have? (Minimum of THREE years required)
What type of clients have you worked with? (Dementia, etc.,)
Are you comfortable with personal care?
What is your availability?
Weekdays
Weekends
Overnight
Fill-in
Do you have a valid drivers license?
Yes
No
Do you have your own personal vehicle?
Yes
No
Are you willing to undergo a background check?
Yes
No
Do you have valid auto insurance in your name?
Yes
No
Please list any certifications you may have (Optional - HHA, CNA, etc.,)
Upload Resume (Optional)
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of
Please provide at least TWO professional references (Name, Phone #, Relationship, Years known).
I understand that Carelink Services is not a home care agency, but a private care coordinator that connects families with independent caregivers. I am applying as a 1099 contractor and am responsible for my own taxes and insurance.
Yes
No
If transporting clients, I confirm that I have valid auto insurance and understand I am solely responsible for transportation-related liability.
Yes
No
Signature
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