Caregiver Application Form

Personal Information
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Educational Background  New Educational Background

Employment History  New Employment History

Please provide your latest employer information below.

Skills/ Preferences

Availability
Experience
General
Language
Personal Care
Pets
Transportation
Vehicle Type

References   New Reference

Miscellaneous Questions

Q.) What do you consider the most challenging aspect of working with older adults?
Q.) List any additional skills or training you possess that would support you in this caregiving role:
Q.) Describe any professional or personal caregiving experience relevant to working with seniors or adults needing assistance.
Q.) What attracts you to work in caregiving, and what do you find most reqarding about working with seniors?
Q.) Are you listed on any child or adult abuse registry?
Q.) Please specify any preferred working days & times below: (Example: Monday From 9AM to 2PM)
Q.) Do you have Lifting Restrictions? (I.E. Lifting, Bending, Stooping, Pulling, or doing household chores?) If so, Please explain:
Q.) Are you okay working in a Smoking Environment?
Q.) Have you had any moving traffic violations in the past 5 years? If Yes, Please Explain:
Q.) Have you ever been convicted of a felony or misdemeanor? If Yes, Please Explain:
Q.) Have you lived in NC for the past 5 years?
Q.) May we contact any of your employers? If so, please add the names of those we can contact.
Q.) Do any of your friends, relatives or spouse work here? If so, who?
Q.) Have you previously applied to or been employed with Sherrie? If so, when?
Q.) Please read and Sign Below: I certify that the information provided in this application is true and complete to the best of my knowledge. I authorize Sherrie’s In-Home Care, LLC to verify any information provided and to conduct any background checks necessary for employment consideration. I understand that employment with Sherrie’s In-Home Care, LLC is “at-will,” meaning that I or the company may terminate employment at any time, with or without cause. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in Discharge. I understand also that I am required to abide by all rules and regulations of the employer..
Q.) What is your desired hourly compensation?

* Caregiver Signature

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