Caregiver Application (Pool)

  • Caregiver Application

    Independent Contractor (Pool)

  • Thank you for your interest in joining our caregiver network.

    As an existing employee, you’ll be among the first considered when new clients are matched with caregivers, based on availability, location, and client preferences.

    Submissions are reviewed, and qualified applicants may be added to our caregiver pool.

    Please note:

    • Being added to the pool does not guarantee work
    • You will be contacted only if a suitable assignment becomes available
    • If you need more time, please use the Save button to save your progress and return later
       

     Click Start to begin your application.

  • Thank you for your interest in joining our caregiver network.

    This application is for 1099 Independent Contractor opportunities. Submissions are reviewed, and qualified applicants may be added to our caregiver pool.

    Please note:

    • Being added to the pool does not guarantee work
    • You will be contacted only if a suitable assignment becomes available
    • As a 1099 contractor, you are not an employee and are responsible for your own taxes and insurance
    • You will be required to upload your resume as part of this application
    • If you need more time, please use the Save button to save your progress and return later
       

     Click Start to begin your application.

  • Contact Information

  • Format: (000) 000-0000.

  • Demographics

  • Caregiver Screening

  • Caregiver Screening

  • Rows

  • Caregiver Screening

  • Rows

  • Caregiver Screening

  • Caregiver Screening

  • Caregiver Screening

  • Caregiver Screening

  • Caregiver Screening

  • Education & Experience

  • Education & Experience

  • PCW Questionnaire

  • Please answer the following questions honestly regarding your physical abilities to perform the tasks commonly required of personal care workers:

  • Professional References

  • Caregiver Profile

  • Please write a short professional profile that we may use to introduce you to potential clients on our website or in client materials.


    Your profile should include:
     

    • Your caregiving experience (how long you’ve worked and types of clients served)

    • Certifications or specialties (CNA, PCW, CPR, dementia care, etc.)

    • A few personal traits or values (e.g., compassionate, reliable, patient)

    • Languages spoken (if applicable)

    • Anything else you’d like clients to know

    Example:

    Hello! My name is Maria and I’ve been a caregiver for over 5 years, assisting seniors and individuals with disabilities. I am a certified CNA with CPR and First Aid training. I specialize in dementia care and pride myself on being dependable, kind, and respectful. I speak both English and Spanish and strive to help clients feel comfortable and safe in their homes.

  • 0/1000

  • If you’d like to include a photo with your caregiver profile, please upload a clear, friendly headshot. This is optional and not required to complete your application.

  • Resume

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Applicant Attestation and Consent

    By submitting this application, I certify that all information I have provided is true, accurate, and complete to the best of my knowledge.

    I understand that providing false or misleading information may disqualify me from being considered for the caregiver pool or result in removal if discovered later.

    I further understand and consent that, as part of the application and screening process, the agency may obtain the following reports:

    • Criminal background check
    • Motor Vehicle Record (MVR) check
    • Credit history check


    I authorize the agency and any authorized third-party service provider to conduct these screenings and to use the results to determine my eligibility for assignments.

    I acknowledge that submitting this application does not guarantee work or placement, and that any future assignments are offered at the discretion of the agency based on client needs and qualifications.

  • Powered by Jotform SignClear
  •  - -
  • Should be Empty: