Cozy Caregivers Employment Application
Thank you for your interest in Cozy Caregivers team please complete the application below so we can learn more about your experience and availability.
Personal Information
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Caregiver Experience
Do you have previous caregiver experience?
*
Yes
No
How many years of caregiving experience do you have?
*
Which of the following areas do you have experience with?
*
Personal Care (bathing, dressing, grooming)
Dementia Care
Meal Preparation
Transfers (assisting with mobility)
Other
Employment History
Job 1 Details
*
Job 2 Details
Job 3 Details
Availability & Preferences
What type of position are you seeking?
*
Full Time
Part Time
On Call
Which shifts are you available for?
*
Days
Evenings
Overnight
Weekends
Other
Which shifts are you available for?
*
[object Object],[object Object],[object Object]
Please specify your available shift
Please specify your available shift
*
References
Reference 1 Full Name
*
First Name
Last Name
Reference 1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 1 Email Address
*
example@example.com
Reference 2 Full Name
*
First Name
Last Name
Reference 2 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 2 Email Address
*
example@example.com
Reference 3 Full Name
*
First Name
Last Name
Reference 3 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 3 Email Address
*
example@example.com
Clearances
Please indicate which of the following clearances you currently hold:
Criminal Background Check
FBI Fingerprints
Tuberculosis (PPD)
Child Abuse Clearances
Document Uploads
Please upload your driver's license, CPR certification, TB test, and physical resume (you may select multiple files).
*
Upload Files
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