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860 216 0496 / 203 560 6506
info@companioncares.com

Mon - Fri 8.30 - 5.00
Saturday - Sunday CLOSED

 

Caregiver Opportunities

You can work close to your home anywhere from a few hours to 24 hours per day based on your own schedule and needs. 

Do you have the skills but need experience?

Companions & Home Helpers ensures that you get the experience you need to advance in today’s growing home care industry. Give us a call to see what opportunities are available.
caregiver

Our caregiver hiring process consists of:

  • Performing nationwide sex offender and criminal background checks
  • Drug and alcohol testing
  • Verification of references, education, and certification
  • DMV registration and car insurance verification for drivers

 Please complete the form below fully for any caregiver employment opportunities.

    BACKGROUND INQUIRY

    I understand that an investigative background inquiry is to be made on myself including, but not limited to, consumer credit history, criminal history, driving history, education and other reports. These reports may include information as to my character, work habits, job performance, and experience, along with reasons for termination of past employment. I further understand that information will be requested from various federal, state, and other agencies which may maintain records concerning my past activities relating to my driving, credit performance, criminal conduct, civil court, and other experiences.

    I authorize, without reservation, any party or agency contacted to furnish the information below.

    I hereby consent to you obtaining the information below. I further understand that to aid in the proper identification of my file or records, I am providing the following information, as well as any other information that may be required at a later date. If hired, I understand that background inquiries will be performed every month.

    HAVE YOU EVER BEEN CONVICTED OF A CRIME?YesNo

    In what state and year?

    APPLICANT INFORMATION

    First Name:

    Middle Name:

    Last Name:

    Date of Birth:

    Home Phone:

    Cell Phone:

    Can we contact you via text for open shifts?

    Mobile carrier:

    Email address:

    Ethnic Group:

    Please specify:

    What other languages do you speak? 

    Position applied for:

    Date available:

    Desired salary:

    AVAILABILITY

    What days/hours are you available to work?  

    How did you hear about us?

    Which friend?

    Please specify:

    Do you have any allergies?

    What kind?

    Do you have reliable transportation?

    Do you own a car?

    Do you know how to use the hoyer lift?

    Are you a citizen of the United States?

    If no, are you authorized to work in the U.S.?

    Have you ever worked for Companions and Home Helpers?

    If yes, when?

    Have you ever been convicted of a felony?

    If yes, explain:

    Current Address:

    How long at address?

    City:

    State:   Zip Code:

    Previous Address:

    How long at address?

    City:

    State:   Zip Code:

    EDUCATION

    Last School/College Attended:

    State:   

    Last Year Attended:

    Graduated?   
    Registered and/or graduated under what name?  

    If you graduated, indicate:

    Degree Level/Major:

    High School:

    Address:

    From: 

    To: 

    Did you graduate? Degree:

    College:

    Address:

    From: 

    To: 

    Did you graduate? Degree:

    Other:

    Address:

    From: 

    To: 

    Did you graduate? Degree:

    EMPLOYMENT HISTORY

    Company/Client:  

    Supervisor:  

    Phone:  

    Address:  

    City:

    State: Zip Code:

    Job Title:  

    From:  
    To:  

    Job Responsibilities:  

    Reason for Leaving: 

    May we contact your previous supervisor for a reference?

    Company/Client:  

    Supervisor:  

    Phone:  

    Address:  

    City:

    State:   Zip Code:

    Job Title:  

    From:  
    To:  

    Job Responsibilities:  

    Reason for Leaving:  

    May we contact your previous supervisor for a reference?

    PROFESSIONAL REFERENCES

    Full Name:

    Relationship:

    Company:

    Phone:  

    Address:

    City:
    State: Zip Code:

    Full Name:

    Relationship:

    Company:

    Phone:  

    Address:

    City:
    State: Zip Code:

    Full Name:

    Relationship:

    Company:

    Phone:  

    Address:

    City:
    State: Zip Code:

    EMERGENCY CONTACT

    Name:

    Relationship:

    Phone:

    Address:

    City:

    State: Zip Code:

    MILITARY SERVICE

    Rank at Discharge:

    Type of Discharge:

    If other than honorable, please explain:

    I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatements of fact, I am subject to disqualification, dismissal, or other action pursuant to employment agency policy and procedure, and subject to criminal penalties as prescribed by law. (Regulation Section 20-670-2(a))

    Attach Resume:(if applicable)

    Attach CNA/PCA/HHA certification:(if applicable)

    Attach COVID vaccination card/test result

    Applicant's Signature:

    By typing my name below I certify that the statements made on this application are true and complete to the best of my knowledge, and are made in good faith.

    HELPFUL HINTS

    Mac Users –
    The date format on this form is
    YYYY-MM-DD
    Having problems with the application form?
    Click HERE to be added directly into our database

    © Companions & Home Helpers, LLC. 2017 • Tel: 18006873820 • CT DCP Registration #HCA.0000234

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