Caregiver Applicant Form

Personal Information

* First Name

*Last Name

* Email

* Address Line 1

Address Line 2

* Country

* State/Province

* City

* Zip/Postal Code

*Gender

* Mobile Phone

* Home Phone

*Date of Birth

* SSN

Educational Background New Educational Background

School/College/University

Qualification

Attach Document

Employment History New Employment History

Please provide your latest employer information below.

Employer Name

Phone Number

Address

Country

State/Province

City

Zip/Postal Code

Served From

Served To

Position Held

Attach Document

References New Reference

Name

Phone Number

Miscellaneous Questions

Q.) How did you hear about Silver Lantern Homecare?

Q.) What specific days and times are you available/willing to work?

Q.) Are you available/willing to work overnight shift?

Q.) Are you looking for full-time or part-time employment?

Q.) How many miles from your home are your willing to drive to see a client?

Q.) What are your salary requirements ($/hr)?

Q.) Have you ever been convicted of a felony? If so, when, where, and disposition of offense?

Q.) How did you hear about Silver Lantern Homecare?

Q.) Please provide 3 professional references with contact information.

Caregiver Application Form

Personal Information

Educational Background New Educational Background

Certifications

Employment History New Employment History

Skills/ Preferences

References New Reference

Miscellaneous Questions

* Caregiver Signature