Caregiver pre-registration

READ THE STATEMENT AND TYPE YOUR NAME IN THE SPACE PROVIDED BELOW IF YOU AGREE AND ACKNOWLEDGE THE FOLLOWING TERMS: I certify that answers given herein are true and complete to the best of my knowledge and I authorize investigation of all statements contained in this application for pre-registration. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an Independent contractor arrangement which means that the Agency will not be my Employer.

Please note - This electronic pre-registration serves only as a preliminary application and is used to pre-screen applicants prior to an invitation to an in person interview. If chosen applicants will be required to fill out a contract to finalize their registering with our Agency

Please note - if you do not meet the minimum qualifications your pre-registration will be rejected
Personal Information
E-Mail:*
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
Zip Code:*
Home Phone:*
Business Phone:
Cell Phone:*
Work Preference
Services provided? Caregiver or Nanny?*
Minimum Acceptable Hourly wage*
Your average hourly wage requested*
Available for* Full Time Part Time Temporary On Call
Education
Education* GED High School Some College College Bus. or Trade School
Please list any Certifications
Related Knowledge/Skills:*
Employment References - Please list 3 persons you have provided services for - helping your family members will not be considered
Name Of Employer:*
Address Line 1:*
Address Line 2:
City:*
State:*
Zip Code:*
Employed From:*
Employed To:*
Employer Phone:*
type of service*
Reason For Leaving:*
Name Of Employer:*
Address Line 1:*
Address Line 2:*
Address Line 2:*
City:*
State:*
Zip Code:*
Employed From:*
Employed To:*
Employer Phone:*
Type of service*
Reason For Leaving:*
Name Of Employer:*
Address Line 1:*
Address Line 2*
City:*
State:*
Zip Code:*
Employed From:*
Employed To:*
Employer Phone:*
Type of service provided*
Reason For Leaving:*
Personal References - friends or past coworkers (please do not list family)
Please list three (NON BUSINESS RELATED) persons whom have known you for at least 5 years.
Reference Name:*
Address:*
email*
Phone:*
Reference Name:*
Address:*
email*
Phone:*
Reference Name:*
Address:*
email*
Phone:*
Background
HAVE YOU EVER PLED GUILTY TO OR BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?
* Yes No
DO YOU HAVE A VALID DRIVERS LICENSE, A RELIABLE CAR TO GET TO JOBS THROUGHOUT THE DAY AND FULL INSURANCE COVERAGE?
* Yes No
WILL YOU AGREE TO A DRUG TEST AND CRIMINAL BACKGROUND CHECK?
* Yes No
ARE YOU A U.S. CITIZEN OR ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?
* Yes No


UPLOAD YOUR RESUME - THAT INCLUDES YOUR RELATED WORK HISTORY FOR CAREGIVING*

READ THE STATEMENT AND TYPE YOUR NAME IN THE SPACE PROVIDED BELOW IF YOU AGREE AND ACKNOWLEDGE THE FOLLOWING TERMS: I certify that answers given herein are true and complete to the best of my knowledge and I authorize investigation of all statements contained in this application for pre-registration. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an Independent contractor arrangement which means that the Agency will not be my Employer. Please note - This electronic pre-registration serves only as a preliminary application and is used to pre-screen applicants prior to an invitation to an in person interview. If chosen applicants will be required to fill out a contract to finalize their registering with our Agency
By electronically signing this application I authorize Home Care Finest to check my references and employment history
ELECTRONIC SIGNATURE*
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