Role Selection

Please select the role you are applying for from the dropdown menu below.

Personal Information

First name

Last name

Preferred Name

Email

Phone

Address Line 1

City

State

Zip Code

Are you at least 18 years old?

Yes

No

Employment History

How many years of experience do you have in caring for seniors or caring for someone with a disability (includes experience with family and friends)?

Less than 1

Between 1 and 3

More than 3

Employer 1 (Most Recent)

Company Name

Full Address

Phone

Start Date

End Date (Leave blank if still employed here)

Employer 2

(Leave these fields blank if you have only worked for 1 company)

Company Name

Full Address

Phone

Start Date

End Date

Education, Certifications & Licensing

Which of the following certifications/licenses do you currently hold?

What is the highest level of formal education that you have completed?

Please list any other languages that you speak fluently

Please provide the following for details that align with your highest level of formal education:

School Name

Full Address

Phone

Graduation Year

Matching

Below is a subset of the needs that our clients will need advanced assistance for. Please check the box for those that you are willing to support.

Schedule and Availability

Please select the slots for each day of the week that match with your current availability. Your input here will help drive client scheduling.

(Note: 12AM - 4AM & 4AM - 8AM are overnight shifts).

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Saturdays

Sundays

How many hours are you available to care for clients each week?

Less than 10

Between 10 and 20

Between 20 and 30

More than 30

References

Please provide contact details for 3 references who have known you for more than 5 years.

Reference 1

First Name & Last Name

Phone

Email

Reference 2

First Name & Last Name

Phone

Email

Reference 3

First Name & Last Name

Phone

Email

How did you hear about CareWhile Homecare (e.g. Google, LinkedIn, Indeed, Job Fair, Directly from CareWhile Website, Referral - please include name of person who referred you)?

Resume Upload

"I certify that all the information provided in this application are true and correct to the best of my knowledge. I understand that if I am hired, falsified statements will be grounds for termination. I authorize investigation of all statements, references and employers I have provided, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."

Authorization

I agree to the terms and conditions provided by CareWhile Homecare, LLC