A to Z Home Care — Care Advocate Employment Application

A to Z Home Care — Care Advocate Employment Application

Apply to join our compassionate team of Care Advocates. Please complete this mobile-friendly application. Your information is confidential and helps us match you with the right opportunities.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you at least 18 years old?
Are you authorized to work in the United States?
Desired Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Which best describes your path to caregiving?
If you are a family or friend caregiver, please provide the client's name and relationship.
Which Care Advocate roles are you interested in?

Other
Please list any credentials or certifications (e.g., CNA, PCA, CPR, First Aid, etc.):
How many years of caregiving experience do you have?
Please describe your caregiving skills and areas of expertise.
Are you able to assist with transfers and mobility (using gait belt, Hoyer lift, etc.)?
Are you comfortable providing personal care (bathing, toileting, etc.)?
Are there any caregiving tasks or situations you are unable or unwilling to perform?

Weekly Availability: Please select all days and shifts you are available.

Which service areas or locations can you work in?
What is the maximum distance (in miles) you are willing to travel for work?
Do you have reliable transportation?
Do you have a valid driver's license?
Are there any home environments or conditions you are unable or unwilling to work in? (e.g., pets, smoking, stairs)
Employment History (please include your most recent employer, job title, and dates of employment):
Reference #1 — Name, relationship, and phone number
Reference #2 — Name, relationship, and phone number
Are you willing to complete a background screening and meet all employment eligibility requirements?
Do you acknowledge that A to Z Home Care is a drug-free workplace?
Do you acknowledge that a health screening may be required as part of employment?
Short Answer: Why do you want to be a Care Advocate with A to Z Home Care?
Short Answer: Share a time you made a difference for someone in need.
Emergency Contact — Name and phone number
How did you hear about A to Z Home Care?
If referred, please provide the name of the person who referred you.
Upload your resume (optional)

Cancelof
Applicant Electronic Signature
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: