Caregiver Application
Complete this application to be considered for current and upcoming caregiver placements with The Perfect Caregiver for Me, a caregiver placement and referral service in Texas focused on live-in caregivers. Questions: call 346-306-2566 or email Theperfectcaregiver4me@gmail.com.
About You
Full Name
*
First Name
Last Name
Best Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best Email Address
*
example@example.com
City / ZIP or area
*
Availability & Pay
Work Preference
*
Please Select
Live-In
Day Shift
Night Shift
PRN
Desired / Available Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pay Rate or Pay Request (per hour or per shift)
*
Care Experience & Skills
Years of Experience / Experience Summary
*
Certifications
*
CNA
CPR/First Aid
LVN
None
Other
Work-related scheduling or placement requirements we should know about.
*
Live-In Preferences
Do you have reliable transportation?
*
Yes
No
Are you comfortable with lifting and transfers?
*
Yes
No
Final Notes
*
Areas willing to work
*
Dallas/DFW
Houston/New Caney
San Antonio/New Braunfels/Seguin
Other
Willing to travel or relocate
Other
Live-in sleeping arrangements accepted
Private bedroom
Shared bedroom
Sofa/common area
Flexible
Preferred time off
Every other weekend
One day weekly
Two days weekly
Rotating/flexible
Other
Other
Placement Readiness
Live-in rotations accepted
5 on / 2 off
7 on / 2 off
7 on / 5 off
Extended live-in
Flexible
Relevant care experience
Independent / companionship
Personal care / ADLs
Mobility / transfer assistance
Memory care / dementia
Higher-acuity / total care experience
Other relevant experience
Other
Hands-on care skills
Bathing
Dressing / grooming
Meal preparation
Medication reminders
Transfers
Hoyer lift
Wheelchair / mobility
Housekeeping / laundry
Other
Maximum care level you’re comfortable with
Please Select
Independent / low
Moderate
Full assist / high acuity
Number of residents you’re comfortable caring for
Final Notes
Comfortable with residents who wake overnight?
Yes
No
Willing and able to transport residents if required?
Yes
No
Cooking ability
Please Select
None
Basic
Comfortable
Strong
Resume upload
Upload Resume
Drag and drop files here
Choose a file
Resume (PDF, DOC, or DOCX)
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of
Professional reference 1
Professional reference 2
Willing to complete a background screening?
Yes
No
Do you currently have U.S. work authorization?
Yes
No
Would sponsorship be required?
Yes
No
Best time to interview
Hour Minutes
AM
PM
AM/PM Option
Submit
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