Caregiver

Personal Information

Format: (111) 123-4567
Note: We may call or text you about this job.
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Questions

Application Questions:

Are you available to work in Maryland? If so, which counties? (We service these 3 counties: Frederick, Washington, or Carroll)
Frederick County Washington County Carroll County More than one county or Multiple Locations None of the above

Which City or Town do you live in?

Are you available to start work within 1-2 weeks?
Yes No

What is your availability for work? (Check all that apply)
Weekdays Weekends Mornings Afternoons Evenings Overnights

Do you want to work, Full-Time, Part-Time, or PRN (as necessary)?
Full-Time (30+ hours a week) Part-Time (Less than 29 hours per week) PRN (As Necessary; at least 1 shift a month)

Do you have a current/valid Driver’s License?
Yes No

Do you have reliable transportation?
Yes No

Have you worked with Assisting Hands of Frederick before?
Yes No

Are you currently a Certified Nursing Assistant (CNA) ?
Yes, Active Yes, but Expired No

Are you able to provide a copy of Valid Car Insurance?
Yes No

Do you live in the state of Maryland?
Yes No

Please choose the best description of your reliable transportation
I own my own vehicle I share a vehicle with someone else Someone drives me to and from my shifts I use Uber/ride share

Please select the option that best describes your experience.
Family and Friends With a home care agency In a facility setting

Were you referred by an employee of Assisting Hands?
Yes No