Employment

At HomeCare, Inc. is always looking for experienced and qualified care professionals to provide care and support to our clients and their families.

Please call us at (888) 828-8802 or (760) 880-2227 or fill out the employment form to begin your rewarding career.

Applicant Information
Name
Last

First

Phone
Address
Street name and no, Suite or Apt no, City, State, Zip
Position Applied for Email Address
Preferred Schedule Part-Time Full Time Live-In Date Available
Do you have a valid CA driver's license? Desired Salary?
Are you a citizen of the United States? If no, are you authorized to work in the U.S.?
Have you ever been convicted of felony? If yes, explain
Previous Employment
Company Address
Phone Job Title Supervisor
Starting Salary   Ending Salary   From  To 
Reason for Leaving? Responsibilities
Company Address
Phone Job Title Supervisor
Starting Salary   Ending Salary   From  To 
Reason for Leaving? Responsibilities
Caregiver Experience
How long in a board and care facility?   years   months
Conditions and duties you have experience with (check all that apply):
Bathing Blood Pressure Check Toileting Dressing/Grooming Hospice Patients
Diet/Nutrition Medical Supervision Oxygen Laundry/Ironing Stroke Patients
Diabetes Blood Sugar Check Cooking Incontinence Alzheimer/Dementia
Professional accreditation or certification as it applies to medical, caregiver or additional information pertaining to your hospice experience, please describe here:
Please list all your references here (name, company, address, phone, relationship)

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in release. If this form is submitted via email, an applicant's name type in the signature box constitutes forgoing conditions that answers are true, complete, and to the best of applicant's knowledge.

Signature Date