Caregiver Application
Name
*
First Name
Middle Name
Last Name
Phone Number
*
E-mail
*
example@example.com
If applying for a specific position, list the job title here:
Total number of years experience in home care:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
I meet the following requirements (check all that apply):
*
Passion for personal care
Professional Outlook
Knowledgeable about ages & stages
Stellar references
Reliable & prompt
Able to commit to job timeline
18+ years old
Clear driving record
Safe & ensured vehicle
Non-smoker
Can legally work in the U.S.
Current CPR/FA certification or willingness to renew
Pass Drug Screening
Pass National Background Check
Are you 18 years of age or older?
*
Yes
No
Are you authorized to work In The United States?
*
Yes
No
What counties are you interested in working ?
*
Edgefield
Saluda
Greenwood
McCormick
Aiken
Lexington
Where are you located?
Please list the county you reside in.
Do You Own A Car?
*
Yes
No
Do You Have A Drivers License?
*
Yes
No
Areas you are comfortable commuting to:
Distance Willing To Travel?
Please Select
Over 30 Mile Radius
Below 30 Mile Radius
Public Transit Only
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Employment Desired:
Date You Can Start
-
Month
-
Day
Year
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Salary Desired
Days Available To Work (check all that apply):
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Other
Experienced With:
Special Needs
Dementia
Adults
Children
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Skills/Qualifications:
Introduce yourself to a prospective employer by sharing a personal letter about your experience. Include qualities that make you an outstanding caregiver and why you've chosen this profession:
Important Note: This is much more than a job to us. We are looking for caregivers that understand the significance of being welcomed into a family to nurture their children. Additionally, we highly value professional letters written with attention to detail (grammar, punctuation, etc.).
List three words that describe your personality:
What skills and experience do you have that are useful for this position? Feel free to be as in depth as possible.
CPR/First Aid Certified?
*
Please Select
Yes
No
Willing to Get Certified
CPR/First Aid Expiration Date
*
-
Month
-
Day
Year
Name of CPR/FA instructor:
Phone number for CPR/FA instructor:
Can You Swim?
Please Select
Yes
No
List any additional health & safety trainings:
Anything else you would like to share:
Are you afraid of pets or have any medical restrictions?
*
OPTIONAL: Upload a recent photo of yourself (5MB or smaller gif, png, jpg, or jpeg file)
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Education:
Highest Level of Education:
*
Please Select
High School
College
Graduate School
High School
Name of High School Attended
Graduated High School?
Please Select
Yes
No
College
Name of College/University Attended
Graduated College?
Please Select
Yes
No
Number of Years Attended College
College Area of Study/Degree
Graduate School
Name of Graduate School Attended
Graduated Grad School?
Please Select
Yes
No
Number of Years Attended
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Graduated From Trade School?
Please Select
Yes
No
Number of Years Attended
Area of Study/Degree
List of other professional training:
i.e. STARS, NCS, Doula training, conference workshops, etc.
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Mandatory Job History
Current Employer Name
i.e. Name of Family
Current Employer Position
Your job title
Current Employer Salary
Current Employer Start Date
-
Month
-
Day
Year
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Current Employer Location
i.e. Neighborhood
Current Employer Children's Ages
Current Employer Duties
Please include an in-depth job description
Current Employer May We Contact?
Yes
No
Please explain why we may not contact your current employer:
Previous Employment
Previous Employer
i.e. Name of Family
Previous Employer Position
Your job title
Previous Employer Salary
Previous Employer Start Date
-
Month
-
Day
Year
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Previous Employer End Date
-
Month
-
Day
Year
Date Picker Icon
Previous Employer Location
i.e. Neighborhood
Previous Employer Children's Ages
Previous Employer Duties
Please include an in-depth job description
Previous Employer Reason for Leaving?
Previous Employer May We Contact?
Yes
No
Please explain why we may not contact your previous employer:
Third Recent Employer
i.e. Name of Family
Third Recent Employer Position
Your job title
Third Recent Employer Salary
Third Recent Employer Start Date
-
Month
-
Day
Year
Date Picker Icon
Third Recent Employer End Date
-
Month
-
Day
Year
Date Picker Icon
Third Recent Employer Location
i.e. Neighborhood
Third Recent Employer Children's Ages
Third Recent Employer Employer Duties
Please include an in-depth job description
Third Recent Employer Reason for Leaving?
Third Recent Employer May We Contact?
Yes
No
Please explain why we may not contact your third recent employer:
Fourth Recent Employer
i.e. Name of Family
Fourth Recent Employer Position
Your job title
Fourth Recent Employer Start Date
-
Month
-
Day
Year
Date Picker Icon
Fourth Recent Employer End Date
-
Month
-
Day
Year
Date Picker Icon
Fourth Recent Employer Location
i.e. Neighborhood
Fourth Recent Employer Children's Ages
Fourth Recent Employer Employer Duties
Please include an in-depth job description
Fourth Recent Employer Reason for Leaving?
Fourth Recent Employer May We Contact?
Yes
No
Please explain why we may not contact your fourth recent employer:
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References:
Please include at least three
May we contact your references?
*
Yes
No
Reference One
*
Name of Reference
Reference One Relationship
*
Reference One Years Acquainted
*
Reference One Phone
Reference One Email
example@example.com
Reference Two
*
Name of Reference
Reference Two Relationship
*
Reference Two Years Acquainted
*
Reference Two Phone
Reference Two Email
example@example.com
Reference Three
Name of Reference
Reference Three Relationship
Reference Three Years Acquainted
Reference Three Phone
Reference Three Email
example@example.com
Reference Four
Name of Reference
Reference Four Relationship
Reference Four Years Acquainted
Reference Four Phone
Reference Four Email
example@example.com
Reference Five
Name of Reference
Reference Five Relationship
Reference Five Years Acquainted
Reference Five Phone
Reference Five Email
example@example.com
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Cover Letter & Resume:
Please Upload Your Cover Letter
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Please Upload Your Resume
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Acknowledgement
I have uploaded my resume. Without a resume, I understand that my application may not be considered.
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