Employment Opportunities

Reason for application

Full Name

Email

Phone

Date you are available to work?

Do you have a valid CPR/First Aid certificate?

YesNo

If so, when did you receive it and when does it expire?

Do you have a drivers license?

YesNo

Are you comfortable driving clients?

YesNo

Do you have your own reliable vehicle?

YesNo

Do you smoke?

YesNo

Are you comfortable working with clients who smoke?

YesNo

Do you have any health issues that may prevent you from helping clients or performing some chores?

YesNo

If yes, please explain

Are you comfortable helping with:

Meal preparation

YesNo

Laundry

YesNo

Pets (allergies)

YesNo

Housekeeping

YesNo

What are some activities and habits you feel are important to involve in clients' daily routine?

Days of the week you are available to work?

SundayMondayTuesdayWednesdayThursdayFridaySaturday

Hours of the day you are available to work?

Are you comfortable being on-call?

YesNo

If so, how much notice is required?

Are you available for overnight shifts?

YesNo

What areas of the Coast are you available to travel to for work?

Attach your resume

Questions/inquiries or extra information