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RH-Transition Support Caregiver Employment Application
Apply to join our team dedicated to providing non-medical home support services.
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Full Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Address (Street, City, State, Zip)
Your answer
Date Available to Start
MM
/
DD
/
YYYY
Position Applying For (Select all that apply)
Caregiver
Personal Assistant
Home Support Specialist
PRN / On-Call Caregiver
Preferred Schedule
Full Time
Part Time
Weekdays
Evenings
Weekends
Flexible
Average Hours Available Per Week
Your answer
Are you legally authorized to work in the U.S.?
Yes
No
Clear selection
Do you have reliable transportation?
Yes
No
Clear selection
Do you possess a Valid Driver’s License?
Yes
No
Clear selection
Do you have Auto Insurance?
Yes
No
Clear selection
Do you have professional caregiving experience?
Yes
No
Clear selection
Years of Caregiving Experience (If applicable)
Your answer
Types of Clients Supported
Seniors
Post-hospital recovery
Dementia/Memory care
Mobility assistance
Companionship
Family caregiving experience
Describe your professional caregiving experience (e.g., setting, responsibilities)
Your answer
Comfort Level with Caregiving Tasks (Check all you are comfortable assisting with)
Personal care assistance (e.g., bathing, hygiene)
Dressing/grooming support
Mobility supervision/assistance
Meal preparation
Light housekeeping/laundry
Companionship
Transportation assistance (using client's vehicle or driving client)
Recovery support supervision
Routine reinforcement/medication reminders
Why are you interested in working with Ready Hands Home Help?
Your answer
What does excellent client care mean to you?
Your answer
Are you able to arrive on time consistently?
Yes
No
Clear selection
Are you willing to accept short-notice assignments?
Yes
No
Clear selection
Preferred Service Areas (e.g., specific cities or regions)
Your answer
Training & Certifications (Check all that apply)
CPR Certified
First Aid Certified
CNA (Certified Nursing Assistant)
HHA (Home Health Aide)
PCA (Personal Care Assistant)
Other
Please list the expiration dates for your certifications (e.g., CPR: DD/MM/YYYY)
Your answer
Have you ever been convicted of a crime related to caregiving?
Yes
No
Clear selection
If yes, please explain the circumstances regarding the conviction.
Your answer
Are you willing to complete a background check and drug screening?
Yes
No
Clear selection
Previous Employer #1 Name
Your answer
Previous Employer #1 Position
Your answer
Previous Employer #1 Dates Worked (Start Date - End Date)
Your answer
Previous Employer #1 Reason for Leaving
Your answer
Professional Reference #1 Name
Your answer
Professional Reference #1 Relationship to you
Your answer
Professional Reference #1 Phone Number
Your answer
Professional Reference #2 Name
Your answer
Professional Reference #2 Relationship to you
Your answer
Professional Reference #2 Phone Number
Your answer
I understand that Ready Hands Home Help provides non-medical home support services and employees must follow agency policies, professional boundaries, and scope of practice.
I acknowledge and agree to this statement.
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