Caregiver Application Form

Personal Information
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Educational Background  New Educational Background

Minimum one certificate is mandatory to be filled.

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

Skill Type

References   New Reference

Miscellaneous Questions

Q.) What is your availability to work? (6am-2pm, 2-10pm, 10pm-6am shifts)
Q.) Are you authorized to work in the United States of America?
Q.) Are you comfortable to work with both male and female clients?
Q.) Are you comfortable to work with both non-agressive dogs and cats?
Q.) Do you have a reliable mode of transportation?
Q.) Describe yourself in three words.
Q.) Do you have any specialized training? (ex: Hospice, Dementia, Alzheimers, Parkinsons)
Q.) What equipment do you have experience with? (ex: Gait belt, walker, wheelchair, hoyer lift, transfers)
Q.) If you have a valid California HCA Registry #, what is it? (This ID number begins with a "7" or a "4")
Q.) If you drive, can you furnish current car documentation? (ex: car insurance in your name, car registration, clean driving record, drivers license)
Q.) Does Therapeutic Home Care have your permission to verify your references listed on this application?

* Caregiver Signature

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