ApplicationFormThank you for your interest in becoming a Care Associate at CarePal. Please fill out the application form below:"APPLY NOW" (Online Form)Application FormStep 1 of 520%Your Personal InformationYour Name(Required) First Last Address(Required) Street Address City ZIP / Postal Code TelephoneCellphone Number(Required)Email(Required) California Driver License:Social Security Number:TIN:Date of Birth MM slash DD slash YYYY Date of Last PE: MM slash DD slash YYYY Date of Last TB Test: MM slash DD slash YYYY Emergency Contact:Name:Phone Number:Relationship:EDUCATIONAL BACKGROUND:ElementaryLocationDate of Graduation MM slash DD slash YYYY High SchoolLocationDate of Graduation MM slash DD slash YYYY College(Required)Degree and MajorLocationDate of Graduation MM slash DD slash YYYY Post Graduate Studies/OthersDegree and MajorLocationDate of Graduation MM slash DD slash YYYY Type of Assignment Desired: Live-in Live-outMinimum Rate Requirement:Day/HourDo you have any experience as a caregiver? YES NOIf yes, how many years?Do you have any of the following certifications? CNA HHA CMA LVNDo you have a CPR and First Aid certification? YES NOIssue Date: MM slash DD slash YYYY How did you hear about us?Job PostingFriendOthers Add RemoveAre you available now? YES NOIf no, when would you be available? MM slash DD slash YYYY Do you have experience in any of the following (please check all that apply)? Alzheimer’s patient Hip replacement patient Hospice Patient care Oxygen Colostomy Bag Sphgymomanometer Take vital signs Parkinson’s patient Stroke patients Patients who require lifting or transfers Nebulizer Treatment Handling catheter bags Change diapers GlucometerRate your ability to cook/prepare American food and follow simple recipes: Excellent Very Good Good Average PoorList your two (2) most recent assignments:Name:Telephone NumberHow long?From MM slash DD slash YYYY To MM slash DD slash YYYY Duties and care rendered (describe the work that you have done for the client):Name:Telephone NumberHow long?From MM slash DD slash YYYY To MM slash DD slash YYYY Duties and care rendered (describe the work that you have done for the client):Summarize your qualifications acquired from previous assignments or other experiences:By clicking “Apply” I hereby certify that the information contained herein is true and correct to the best of my knowledge and agree to have any of the information above verified. In consideration of my receiving an assignment, I agree to conform to the standards of CarePal. I further agree that my assignment can be terminated at anytime, with or without cause and with or without notice. Also, by clicking "Apply," I agree to CarePal’s terms of service and privacy policy.
