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Companion/Caregiver Job Application
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* Indicates required question
Full Name
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Address (street, city, state, zip)
*
Your answer
Emergency Contact Information (Name, Phone, Relationship)
*
Your answer
Are you at least 18 years of age?
*
Yes
No
Are you currently employed?
*
Yes
No
How many hours a week do you prefer?
*
Your answer
When are you available to begin work?
*
MM
/
DD
/
YYYY
Do you have a valid driver's license? (This is required for employment with us)
*
Yes
No
Do you have your own reliable vehicle?
*
Yes
No
Do you have current auto insurance?
*
Yes
No
How many years experience do you have for this job?
*
Your answer
Have you ever been convicted of a felony? (Record of conviction does not necessarily disqualify an applicant from employment considerations.)
*
Yes
No
Why do you want to be a companion/caregiver?
*
Your answer
Please rate each one based on how important it is to you for your employer.
*
1 (Not very important)
2
3 (Very important)
Communication
Training
Pay
Appreciation
Culture
Management
1 (Not very important)
2
3 (Very important)
Communication
Training
Pay
Appreciation
Culture
Management
How did you hear about The Grandson Home Care?
*
Your answer
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