First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone *

Email *

Gender

Male
Female
No elements found. Consider changing the search query.
List is empty.

Are You CPR Certified? *

Are You CPR Certified?

Yes
No
No elements found. Consider changing the search query.
List is empty.

What certifications or caregiver training do you have? Please List. *

Do You Have A Car? *

Do You Have A Car?

Yes
No
No elements found. Consider changing the search query.
List is empty.

What shifts are you available to work? (Check all that apply) *

Live-in (24 hours)

Morning 6 AM - 12 PM

Afternoon 12 - 4 PM

Evening 4 - 10 PM

Overnight 10 PM - 6 AM

What days are you available to work? (Check all that apply) *

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

How did you hear about us? *

Caregiver Requirements:

All employees must upload an unexpired State ID (Driver’s License, US Passport, US Visa, Permanent Resident Card, or Employment Authorization Card) and copy of your Social Security Card.

Attach Document *

Upload Files

Please list three work references

Reference #1: Company *

Reference #1: Dates of Employment *

Reference #1: Name of Supervisor *

Reference #1: Phone *

Reference #2: Company

Reference #2: Dates of Employment

Reference #2: Name of Supervisor

Reference #2: Phone

Reference #3: Company

Reference #3: Dates of Employment

Reference #3: Name of Supervisor

Reference #3: Phone

COVID-19 TEST RESULT

All employees must provide a negative Covid-19 PCR result prior to employment. Intermittent screening will be required per CDC guidelines.

Certification /Background Check Consent

National Background completed within the last year or check the box below to give consent. Must Have a Clean Background

Upload Completed Background Check

Consent Screening/Background Check *

By checking this box you give consent to Elderly Caregivers, LLC to run a national background check.

Certify That Statements Are True *

I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that withholding, misrepresentation, or falsification of information shall be grounds to refuse employment, or, if employed, shall be grounds for dismissal.