Apply for Elite Caregiver (5 years experience)

Openings >> Elite Caregiver (5 years experience) >> Apply

Hello and thank you for your interest in Home Instead. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 999 Reddoch Cove, Memphis TN 38119 . Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at 901.682.8600.

Summary
Title:	Elite Caregiver (5 years experience)
ID:	29
Location:	Memphis, TN
Contact Information
* First Name:
* Last Name :
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

	- or Upload from:


Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Additional Information

* How did you hear about Home Instead?

If applicable, please specify:

CAREGiver v4 Employment Application

BASIC INFORMATION

* Have you ever submitted an application here before?

Yes No

If yes, when?

* Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?

Yes No

WORK HISTORY

MOST RECENT EMPLOYER

* Are you currently working for this employer?

Yes No

* If yes, may we contact?

Yes No

* Company Name:

* City:

* State:

* Company Phone:

* Dates Employed - From:

* Dates Employed - To:

* Duties:

Reason for Leaving:

REFERENCES

If you are considered for a position, we may contact your references and would ask that you notify them in advance. Please do not list relatives or family/relations.

Professional References

Full Name	Phone Number	Best Time of Day to Call	Email	Relationship (No Relatives)	Number of Years Known
*	*	* AM PM		*	*
*	*	* AM PM		*	*

Personal References

Full Name	Phone Number	Best Time of Day to Call	Relationship (No Relatives)	Number of Years Known
*	*	* AM PM	*	*
*	*	* AM PM	*	*
*	*	* AM PM	*	*

APPLICANT NOTE

Home Care of Memphis, LLC is an independently owned and operated Home Instead® franchise 999 Reddoch Cove, Memphis TN 38119 901.682.8600.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents to verify any of the information included in this application. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

CAREGiver Prescreen Questions

* Are you 18 years of age or older?

	Yes
	No

* Are you able to lift 25 pounds?

	Yes
	No

* Do you have reliable transportation?

	Yes
	No

General Questions

* What is your birthday?

* Please list an emergency contact.

If you have been employed, what date were you hired?

* You have read the job description for the position for which you have applied. Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?

	Yes
	No

* Why are you interested in employment with us?

Availability

* Are you available to work on the weekends? (Saturday-Sunday)

	Yes
	No

* Please indicate the earliest hour you want to start your shift and the latest hour you can work

* What are the hours you desire?

* Due to the nature of our business, no guarantee can be made as to the schedule or the amount of hours worked.

What date are you available to begin work?

* Are you available for full-time(30 or more hours per week) work?

	Yes
	No

* Are you available for part time(less than 30 hours per week) work?

	Yes
	No

* Are you available for morning shifts?

	Yes
	No

* Are you available for afternoon shifts?

	Yes
	No

* Are you available for evening shifts?

	Yes
	No

* Are you available for overnight shifts?

	Yes
	No

* Are you available to work weekdays? (Monday-Friday)

	Yes
	No

* What weekdays are you available to work?

* What weekend days are you available to work?

Follow-up questionnaire - caregiving experience

Follow-up questionnaire – caregiving experience

Please indicate those tasks in which you have experience. For the areas that you do not have experience, please note if you are willing to learn.

Tasks	Experience Yes/No	Willing to Learn
Companionship/Conversation	* Yes No	Willing to Learn
Meal Preparation (meals/snacks)	* Yes No	Willing to Learn
Housekeeping (dust, vacuum, laundry)	* Yes No	Willing to Learn
Bathing/showering Assistance	* Yes No	Willing to Learn
Dressing Assistance	* Yes No	Willing to Learn
Showering Assistance	* Yes No	Willing to Learn
Medication Reminders	* Yes No	Willing to Learn
Hospice Care	* Yes No	Willing to Learn
Stroke Care	* Yes No	Willing to Learn
Dementia Care	* Yes No	Willing to Learn
Incidental Transportation & Errands	* Yes No	Willing to Learn
Incontinence Care	* Yes No	Willing to Learn
Personal Care Assistance (Female)	* Yes No	Willing to Learn
Personal Care Assistance (Male)	* Yes No	Willing to Learn
Alzheimer’s or Dementia Care	* Yes No	Willing to Learn
Diabetes Care	* Yes No	Willing to Learn
Hearing Impairment	* Yes No	Willing to Learn
Transferring Assistance (Example: helping a person from chair to standing position)	* Yes No	Willing to Learn
Ambulation Assistance (Example: Ensure a person’s stability and safety when moving)	* Yes No	Willing to Learn
Mechanical Lift (Hoyer Lift)	* Yes No	Willing to Learn

* How many years of experience do you have as a caregiver?

Applicant Note & Certification

APPLICANT NOTE

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

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