Caregiver Application Form

Personal Information
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Educational Background  New Educational Background

Certifications

Employment History  New Employment History

Please provide your latest employer information below.

Completion of a minimum of one skill/preference is required.

Skills/ Preferences

Availability
Cooking Skills
Experience
Language
Personal Care
Pets
Skill Type
Transportation
Vehicle Type

References   New Reference

Miscellaneous Questions

Q.) What date would you be available to start?
Q.) What shift durations work best for you?
Q.) Are you able to drive clients?
Q.) How many years of previous experience in Home Care?
Q.) Are you comfortable with Bed Bound Care?
Q.) Do you have a smart phone?
Q.) Do you have any unique skills or interests that could contribute to our team?
Q.) Are you at least 18 years of age?
Q.) Are you presently employed?
Q.) Are you eligible to work in the U.S.?
Q.) How did you hear about Proper Home Care?
Q.) What are you salary requirements
Q.) Are you able to perform end of life care?
Q.) Where in the great Austin metropolitan areas do you prefer to work?
Q.) What shifts work best for you? (If more than one let us know in the comments)
Q.) What client genders will you be comfortable working with?
Q.) Are you comfortable working in a home with pets? (Please let us know any exceptions in the comments)
Q.) Are you comfortable working in a home with smokers?
Q.) Are you comfortable performing transfers using a Gait Belt?
Q.) Are you comfortable performing transfers using a Hoyer Lift?
Q.) Are you comfortable preparing meals and performing light housekeeping?
Q.) What are you passionate about outside of work? Sports? Hobbies?
Q.) Is there anything else you would like us to know about yourself that is not covered in this application which may be relevant?
Q.) Have you ever been convicted of a felony? If so, when, where and what was the disposition of the offense?
Q.) Do you have any formal Dementia training. If so, where and how long ago?
Q.) Please list a name and contact number for each of your Employment History References listed above.

* Caregiver Signature

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