Caregiver Application Form

Personal Information

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Educational Background  New Educational Background

Employment History  New Employment History

Please provide your latest employer information below.

Minimum one Skills/Preferences is mandatory to be filled.

Skills/ Preferences

Availability
Cooking Skills

Experience












General
Language

Level of Ability
Personal Care

Pets
Transportation


References   New Reference

Miscellaneous Questions

Q.) Are you Covid vaccinated?
Q.) Do you have hoyer experience?
Q.) Are you legally eligible for employment in this country?
Q.) Are you available to work overtime if required?
Q.) Do you have any friends or family employed or have been employed at this location?
Q.) Have you been convicted of a crime in the last seven years? If so, please explain.
Q.) Have you ever been convicted of a felony?
Q.) If considered for hiring, will you agree to have criminal background check and fingerprinting performed by GCHEXS at your cost within 5 days of hire?
Q.) If considered for hiring, will you agree to provide a motor vehicle report?
Q.) If considered for hiring, will you agree to a pre-employment drug screen?
Q.) Do you have reliable and legal transportation?
Q.) Rate of pay expected per hour?
Q.) Can you please provide a emergency contact name, relationship and number ?
Q.) What is your availability hours for Monday ?
Q.) What is your availability hours for Tuesday ?
Q.) What is your availability hours for Wednesday ?
Q.) What is your availability hours for Thursday ?
Q.) What is your availability hours for Friday ?
Q.) What is your availability hours for Saturday ?
Q.) What is your availability hours for Sunday ?
Q.) Do we have consent to contact your previous employer?
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