Job Application Form

Lighthouse Caregivers Application
Full Name

First NameLast Name
Your maiden name
Birth Date

MonthDayYear
E-mail
Phone Number

Area CodePhone Number
How did you hear about us?
What is your current employment status?
Do you have a resume? Upload it here.

Upload a File

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We love pictures! Please upload a profile picture of yourself.

Upload a File

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Tell us about your desires as a caregiver. How would you help a senior in need of care?
Are you eligible to work in the U.S
Do you drive?
Do you have a car to get to work?
Available start date:

MonthDayYear
Tell us your availablity (check all that apply)

Other
What days are you available (check all that applies)
Please let us know if you have specific times when you are available
Level of Education

Other
Do have any certifications in the field of health (Please check all that apply)

Other
Have you ever been convicted of a crime? If yes, please tell us about it.
If we consider you for hire, will you agree to a criminal background check?
How many years have you worked as a caregiver?
What type of setting have you worked in as a caregiver? (Please check all that applies)

Other
Your experience (please check all that apply)
We perform a thorough reference check. Please provide 3 professional references which pertain to your experience as a caregiver. We suggest that you provide 3 families whom you have helped, preferably family members who oversee the care. Supervisors are also accepted references.

If you have no experience as a caregiver, please provide 3 professional references, i.e. your supervisors.
Reference #1: (Please provide name and phone number)
Date and duties at this assignment
Reference #2: (Please provide name and phone number)
Date and duties at this assignment
Reference #3 (Please provide name and phone number)
Date and duties at this assignment
Please press submit to send your application immediately. We will review and contact you as soon as possible.
Should be Empty:

Lighthouse Caregivers Application