Do you have a current Article 9 Training certificate? YES NO Do you have Caregiver / Direct Care Worker (DCW) certification? YES NO Many of our shifts are 2-3 hours long a few days a week. A typical schedule would include multiple shifts with different clients. YES NO Can you adapt to multiple shifts and the driving required? It may take some time to get you a full, working schedule. YES NO Can you be flexible? Sometimes we need last-minute, emergency coverage. YES NO Would you be available on short notice for fill-in shifts? Punctuality is a MUST. Reliability is crucial. Clients are depending on our services. YES NO Can you be on-time? If you are going to be absent or late, you must call the office. If you do not call the office, you can be fired. YES NO Do you understand? Many of our clients require lifting and/or transfers. YES NO Do you have experience or training with lifts and transfers? Are you able to lift 100 lbs? YES NO 150 lbs? YES NO Are you able to transfer at least 100 lbs? YES NO 150 lbs? YES NO Starting wage is typically $9.00 per hour. Is this acceptable to you? YES NO Applications are kept on file for 6 months. Submitting an application does NOT guarantee YES NO employment. Do you understand? If no, are you authorized to Are you a citizen of the ? YES NO YES NO work in the ? Are you 18 years of age or older? YES NO Visa Type? Alien Registration # Have you ever worked for this YES NO If so, when? company? Have you ever been convicted of a YES NO If yes, explain felony? AVAILABILITY To provide you better service, please provide, below, your cross streets and availability. Thank you. Cross Streets: Shifts may be early morning or late evening, weekends, once a week or every day. What is your availability? Availability: (Check all that apply) Sun Mon Tues Wed Thurs Fri Sat Available hours: Company Phone ( )
Do you have a current Article 9 Training certificate? YES NO Do you have Caregiver / Direct Care Worker (DCW) certification? YES NO Many of our shifts are 2-3 hours long a few days a week. A typical schedule would include multiple shifts with different clients. Can you adapt to multiple shifts and the driving required? YES NO It may take some time to get you a full, working schedule. Can you be flexible? YES NO Sometimes we need last-minute, emergency coverage. Would you be available on short notice for fill-in shifts? YES NO Punctuality is a MUST. Reliability is crucial. Clients are depending on our services. Can you be on-time? YES NO If you are going to be absent or late, you must call the office. If you do not call the office, you can be fired. Do you understand? YES NO Many of our clients require lifting and/or transfers. Do you have experience or training with lifts and transfers? YES NO Are you able to lift 100 lbs? YES NO 150 lbs? YES NO Are you able to transfer at least 100 lbs? YES NO 150 lbs? YES NO Starting wage is typically $9.00 per hour. Is this acceptable to you? YES NO Applications are kept on file for 6 months. Submitting an application does NOT guarantee employment. Do you understand? YES NO Are you a citizen of the ? YES NO If no, are you authorized to work in the ? YES NO Are you 18 years of age or older? YES NO Visa Type? Alien Registration # Have you ever worked for this company? YES NO If so, when? Have you ever been convicted of a felony? YES NO If yes, explain AVAILABILITY To provide you better service, please provide, below, your cross streets and availability. Thank you. Cross Streets: Shifts may be early morning or late evening, weekends, once a week or every day. What is your availability? Availability: (Check all that apply) Sun Mon Tues Wed Thurs Fri Sat Available hours: Company Phone ( )