#inhomecare #alzheimers #alzheimersawareness #endalz #dementia

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Get a list of all questions you have to ask a homecare provider before hiring

Employment application

Please fill the application and we will contact you within 48 hours for a follow up

Personal information

Experience & Preferences

Reference check

Please, fill your personal information

Are you authorized to work in the U.S.?

Yes No

Do you currently hold a valid drivers license?

Yes No

Do you have a Car?

Yes No

Do you speak a second language?

Yes

Please share more information about your work experience and preferences

Why did you decide to become a caregiver?

Current Certifications
(Multiple choices allowed)

HHA LPN PCA Other CNA None

Assignment Preference
(Multiple choices allowed)

Live-In Hourly Part-Time Hourly Full-Time

Have you worked in Home Care before?
(If yes, how long?)

Less than a year 1-3 Years 4-7 Years 7+ Years I Have Never Worked in Home Care Before.

Have you previously worked with patients affected by:
(Multiple choices allowed)

Alzheimer's Kidney Dialysis Dementia MRDD AIDS/HIV Respiratory Diabetes Arthritis Stroke Cancer Parkinson's Hospice Decubitus Ulcer (Bedsore) Osteoporosis Congestive Heart Failure Depression Chronic Obstructive Pulmonary Disease (COPD) Paralyzed

Have you ever had experience with the following tasks
(Multiple choices allowed)

Client Repositioning Catheter Care Patient Transferring Exercises Colostomy Care Ostomy Care Bed Bath (Sponge Bath) Feeding Tube Assistance Incontinence Care Skin Care Activities of Daily Living (ADL's) Tracheostomy Site Care None

Have you ever had experience with the following equipments
(Multiple choices allowed)

Walker Wheelchair Gait Belt Hoyer Lift Oxygen Tank Blood Pressure Kit Hospital Bed Glucose Monitor Bed Pan Bedside Commode Pulse Oximeter Sliding Board None

Are you willing to cook for clients?

Yes No

Do you have any allergies?

Yes

Are you comfortable working with
(Multiple choices allowed)

Taking Care of Couples Pets in the House Smoking Clients Male Clients None

Personal and professional reference check

Please list your past 3 employers starting from the most recent one.

Are you currently employed?

Yes No

Have you ever applied with us before?

Yes No

Can we send you text messages?

Yes No

How did you hear about us?
(Multiple choices allowed)

Google Referred by Current Employee Social Media (Facebook, Instagram, Linked In) Newspaper Family or Friend

Is there anything you would like to add or any reason you are unable to perform all of the tasks of the position you are applying for?

I understanding the legal work status

Get a quote

Contact the caregiver

Thank you!

We will call back you tomorrow

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