Caregiver
Personal Information
Format:
(111) 123-4567
Note:
We may call or text you about this job.
(Message & Data rates may apply)
Questions
Are you a DSP or a New Jersey CHHA? (Please Select)
DSP (Direct Support Professional)
CHHA (New Jersey Certified Home Health Aide)
No
Are you available to work immediately?
Yes
No
What is your availability?
Day Shifts
Night Shifts
Weekend
Open
How many hours a week can you work for us?
More than 30 hours
21-30 hours
10-20 hours
Less than 10 hours
Are you currently working?
Yes
No
Are you at least 18 years of age?
Yes
No
Do you have the legal right to work in the United States?
Yes
No
Are you willing to undergo a background check?
Yes
No
Are you fully COVID-19 Vaccinated?
Yes (Fully-two shots + booster)
Yes (Partially-not boosted)
No (but willing)
Not willing (fill in reason)
Has anyone referred you to this job?
Yes
No
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