Caregiver Application Form
The starting rate for new caregivers is $15 an hour, with steady increases over time. After you fill out this form, we'll get back to you within two business days as to whether there's a fit. Accepted caregivers will be given a contract and training materials. Afterwards, we'll send placements directly to your email, where you'll get to choose what works for your schedule. Your information here is confidential and can be changed in the future. Thank you for applying!
Full Name
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First Name
Middle Name
Last Name
Email Address
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We'll send new jobs directly to this email.
Phone Number
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Question 1: Have you attained a high school diploma?
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Yes
No
Question 2: Are you legally permitted to work in Illinois?
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Yes
No
Question 3: Do you have previous experience as a caregiver? (we offer training materials and sessions to all new caregivers)
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Yes
No
Question 4: Are you willing to help seniors in the following areas? (you can check multiple boxes, services are provided within reason)
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Meal preparation
Cleaning
Driving & errands
Playing games
Help with bathing
Medication reminders
Question 5: What is your maximum daily time committment?
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Between 4 and 6 hours a day
Between 6 and 8 hours a day
More than 8 hours a day
Question 6: What's the earliest you can reliably work? (this helps with scheduling, you can change this later)
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No scheduling conflicts
By 9:30am
By 10:30am
By 11:30am
Other (specify in additional comments please)
Question 7: What's the latest you can reliably work? (this helps with scheduling, you can change this later)
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No scheduling conflicts
By 3:00pm
By 4:00pm
Other (specify in additional comments please)
Question 8: Which counties would you be open to working in? (you can change this later, please check all that apply)
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Cook
Lake
Will
Dupage
McHenry
Kane
Kendall
Grundy
Question 9: Which days of the week would you prefer to work? (this helps us best accommodate your schedule, please check all that apply)
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Additional Comments: (optional)
Submit
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