Application - Steadfast Care Services

Steadfast Care Services – Caregiver Job Application

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone Number

Desired Position

Companion Caregiver

PCA (Personal Care Assistant)

HHA (Home Health Aide)

CNA (Certified Nursing Assistant)

When can you start?

Do you have prior caregiving experience?

Yes

If yes, please describe:

Certifications (check all that apply):

CNA

HHA

CPR / First Aid

Other Certifications:

Are you comfortable with (check all that apply):

Personal care (bathing, grooming)

Mobility assistance

Meal preparation

Light housekeeping

Dementia/Alzheimer’s care

Pet-friendly homes

Do you have a valid driver’s license?

Yes

Do you have reliable transportation?

Yes

Have you ever been convicted of a crime?

Yes

If yes, please explain:

Are you legally authorized to work in the U.S.?

Yes

Please provide two professional or personal references:

Name / Phone / Relationship:

By clicking on the Submit Form button below, I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false information may disqualify me from employment.