Caregiver Application - The Best Home Care Jobs in San Luis Obispo County

Applicant Information:

First Name:

Middle Name:

Last Name:

Mobile phone:

Alternate phone number:

Email:

How many hours can you work each week?

Your desired hourly wage?

Address

If your mailing address is different than your physical address, please check the Yes box.

Yes

Address

State/Province: *

Address

Match Criteria:

Please select the options that best describe you.

General

Non-smoker

Smoker

Pets

Ok with dogs

Ok with cats

Ok with dogs and cats

Max client weight for transfers:

Education & Training:

High School

High School graduation date

College

College graduation date

Degree received (choose from drop down list)

College Major:

If you didn’t graduate, # of years of college completed:

Employment History (need at least one):

Please provide your most recent positions of employment.

Employer (i.e Company):

Title/Role:

Start Date:

End Date or Present if still employed

Job Duties:

Provide a narrative description of your job duties.

Supervisor (or HR) Name:

Supervisor (or HR) Email:

Supervisor (or HR) Mobile # if available:

Supervisor (or HR) Office Phone Number:

Is it Ok for us to contact this employer?

Yes

City:

State/Provice:

Zip/Postal

Add Additional Employer Remove

Professional References (need at least one):

Please provide professional references.

Name:

Company Name:

Office Phone Number:

Mobile Phone Number if available:

Email:

Relationship With Reference:

How many years have they known you?

Add Additional Reference Remove

Personal References (need at least two):

Please provide personal references.

Name:

Phone Number:

Mobile Phone Number if available:

Email:

Relationship with Reference:

How many years have they known you?

Add Additional Reference Remove

Additional Information:

How did you find us? How did you find us?

If you have experience as a caregiver, please describe it in detail. If you do not have experience, type “none.”

Would you be able to pass a lifetime criminal background check? If no, please explain.

If your mailing address is different than your physical address please enter it below:

IMPORTANT: YOUR ANSWER BELOW IS REQUIRED TO PROCESS THIS APPLICATION!! By typing “YES’ in the box below, I agree to the following terms and conditions of this application: I CERTIFY that the information contained in this application is correct to the best of my knowledge, and I understand that any misstatement or omission of information is grounds for ending the hiring process or dismissal from employment. I authorize verification of information provided on this application; and authorize the references listed above to give Gold Coast Care Inc. all pertinent information concerning my previous employment; and release all parties from all liability for any damage that may result from furnishing the same to Gold Coast Care Inc. I further agree that either I or Gold Coast Care Inc. may terminate my employment with or without cause and with or without prior notice, at any time. No representative of Gold Coast Care Inc. other than an executive officer has the authority to enter into any agreement for employment for any specified period of time. I understand that I may be required to submit to a drug test in accordance with the Gold Coast Care Inc. drug testing policy.

Disclaimer:

Gold Coast Care Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity/expression, national origin, citizenship, military/veteran status, age, medical condition, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications.

Signature:

Signature

Clear

Thank you for your interest in joining our team.

Please complete and submit the application below to be considered for a position as a Home Care Aide.

* Fields are required fields .

Applicant Information:

Match Criteria:

Education & Training:

Certifications and Credentials:

Employment History (need at least one):

Professional References (need at least one):

Personal References (need at least two):

Additional Information:

Disclaimer:

Signature: