Caregiver

First name*

Last name*

Email address*

Location

Phone number*

Resume*

Cover Letter*

In 150 characters or fewer, tell us what makes you unique. Try to be creative and say something that will catch our eye!*

Why do you want to work caring for seniors?*

Do you have access to email to be able to submit your availability and communicate with the office?*

Do you have your own cell phone?*

Many Caregiver assignments require the caregiver to drive to their clients home and also potentially perform errands and transportation for a client . Do you have a valid drivers license and dependable vehicle?*

Please provide the make, model of your car along with your drivers license number and State of issue.*

Work Preferences: Please check all the options that you are interested in.*

Please indicate what days you are available to work:*

Number of hours you would ideally like to work weekly?*

What geographic area(s) would you like to work in?
Please check all that apply.*

What is your highest level of caregiver training and experience?*

Please elaborate on your formal education. List diploma's/degrees achieved/obtained including year completed.

What training or experience do you have working with the elderly? (Either formal or informal)

What do you like most about working with the elderly?*

What do you like least about working with the elderly?

Have you ever been convicted of an offence for which a pardon has not been granted?*

Professional References: Please list three (3) people (who are not related to you) including prior supervisors who can provide a professional reference.
Include: Name / Title/ Company / Phone / Email for each reference.

Personal References: Please list three (3) people (who are not related to you) who can provide a personal reference.
Include: Name / Relationship/ Phone / Email for each reference.

Have any of your relatives ever worked for Seniors Prefer Homecare? Yes/No please include their name(s)

Do / Have any of your friends ever worked for Seniors Prefer Homecare? Yes/No please include their name(s)

Did anyone refer you to the company? Who

Please indicate any languages you can speak, read and/or write. Please include your native language. ie. English - speak/read/write*

Date Available to Start*

Salary or Wage expectations: (hourly)

Provide a summary as to why you think you would make an outstanding addition to our team / caregiver?*

Please provide your level of experience and proficiency in meal preparation for seniors.*

Please indicate your level of experience and proficiency in providing the following home maintenance activities for seniors. Vacuuming, Dusting, Cleaning - Bathrooms and Kitchens, Bed Linen Changes, Laundry and Ironing.

All clients are different, when it comes to providing companionship, please describe yourself.*

Please indicate your level of experience and proficiency in providing the following activities for seniors. Errands, Transportation, Grocery Shopping either for or with a senior client.*

We are interested to know how you found us. Please tell us your source below:

CERTIFICATION AND RELEASE: By electronically submitting this application I certify that I have read and understand the application and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs or alcohol is prohibited during employment. Should I report to work intoxicated or found to be using drugs or alcohol while on the job, the company may terminate my employment for serious reasons, without further compensation, notice or delay.
I have read and understood this statement.*

Would you be willing to take a drug test?*

Do you have car insurance that is current?*

Human Check*