Comfort Keepers Pre-Screening Form
Applicant Details:
How did you hear about us?
*
Please Select
Comfort Keepers website
Indeed
Job Fair
Google
Job Board
Other
Full Name
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First Name
Last Name
Phone Number
*
Email Address
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Address
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Street Address Line 2
City
State / Province
Postal / Zip Code
Are you at least 18 years of age?
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Yes
No
Have you previously been employed by Comfort Keepers?
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Do you have both a valid Drivers License and vehicle insurance?
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Yes
No
Do you have at least 2 years of experience working with the senior population?
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Yes
No
Tell us about your experience:
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Back
Next
Do you have any experience providing personal care (Ex: Bathing; Grooming; toileting; Incontinence care)?
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Yes
No
We service the Greater Antelope Valley and surrounding areas. Are you willing and able to commute a minimum of 20 miles?
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Yes
No
Occasionally, we may assist clients with transportation to doctor's appointments or running errands. Do you feel comfortable driving clients in your own vehicle?
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Yes
No
Are you able to assist clients with transfers, and lift at least 25 pounds?
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Yes
No
Are you registered with the Home Care Aide Registry (HCA)?
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Yes
No
If hired, would you be able to successfully complete a series of background checks—including a criminal record check, driving record check, and drug screening/TB test?
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Yes
No
What is your availability? Please provide specific timeframes. (We require all caregivers to work at least 1 weekend day, including holidays as needed.)
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning
Afternoon
Overnight
Do you prefer a virtual or In-Person interview? (Please select which method works best for you).
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Virtual
In-Person
How soon are you able to start?
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Resume:
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