What Education Qualifies You To Work As a Caregiver? High school City/State Dates College City/State Dates Other City/State Dates Degrees/certificates All Degrees / Certificates must be presented copy. All will be verified with provider/issuer. – Special skills or courses Any skills that assist in making you qualified as a professional Care Provider. – What is Your Past Experience? Discuss any training or experience working with the elderly. How are you trained and/or experienced in working with the elderly? What do YOU do that shows and proves you’re Reliable, Trustworthy and Honest? What would you like least about working with the elderly? Skills Please indicate which of the following skills you are prepared to provide if referred to seniors / families: Companion Medication yes no yes no Oral Care yes no Care & Safety reminders Shaving yes no yes no yes no Alzheimer’s Transportation Assistance Bathing (Reg., Assist w / P.T. yes no yes no yes no Dementia bed, sponge) Exercises Meal Prep / Dressing/ Assist w/ yes no yes no yes no Clean Up Grooming Prosthesis yes no yes no yes no Feeding Incontinence Hospice Light Willing to Work yes no yes no yes no Ambulation Housekeeping w/Pets Speak fluent yes no yes no yes no Laundry Transfer assist English
What Education Qualifies You To Work As a Caregiver? High school City/State Dates College City/State Dates Other City/State Dates Degrees/certificates – All Degrees / Certificates must be presented copy. All will be verified with provider/issuer. Special skills or courses – Any skills that assist in making you qualified as a professional Care Provider. What is Your Past Experience? Discuss any training or experience working with the elderly. How are you trained and/or experienced in working with the elderly? What do YOU do that shows and proves you’re Reliable, Trustworthy and Honest? What would you like least about working with the elderly? Skills Please indicate which of the following skills you are prepared to provide if referred to seniors / families: Companion Care & Safety yes no Medication reminders yes no Oral Care yes no Alzheimer’s yes no Transportation yes no Shaving Assistance yes no Dementia yes no Bathing (Reg., bed, sponge) yes no Assist w / P.T. Exercises yes no Meal Prep / Clean Up yes no Dressing/ Grooming yes no Assist w/ Prosthesis yes no Feeding yes no Incontinence yes no Hospice yes no Light Housekeeping yes no Ambulation yes no Willing to Work w/Pets yes no Laundry yes no Transfer assist yes no Speak fluent English yes no
Employment_Application_Angels.docx