Employment

Homewatch Caregivers Job Openings

We are looking for experienced, responsible, motivated and compassionate people to care for seniors, physically & developmentally disabled people in the Boulder County Area.  Help them with things they can’t do for themselves: ADL’s, personal care, meals, med reminders, mobility assistance, light housekeeping, errands and companionship.  This is not just a job–you will feel great really making a difference in peoples’ lives.

You will be our employee–not independent contractor.  We take care of taxes, offer benefits (medical, dental, prepaid legal, 401k) and competitive wages.  Experience preferred but we will train. No certification required–CNA, CPR, QMAP a plus.  Must have car.  Self-scheduling position, work full or part time, accept only the hours that work in your schedule.

Personal Care Provider Application

Please fill out all fields before submitting.

Name:

Date:


Email:


Phone Number:


Address:


Are you 18 years of age or older?
Yes
No

Have you ever been convicted of a crime?
Yes
No

If yes, please explain:


Are you the subject of any pending criminal proceeding?

Yes

No

If yes, please explain:


Have you ever worked for or applied for a position with Homecare, Inc. and/or Homewatch CareGivers? If yes, please indicate date(s).



Upon offer of employment, in order to complete your background check you will be required to provide your social security number, date of birth, previouis name(s), previous addresses for the past 5 years, and driver’s license number. Employment will be contingent upon the results of criminal background check and driving record.



Position desired:


Date you are available to start:



Education


High School:


Did you recieve a diploma or GED?
Yes

No


College or Post-High School Education


Degree recieved?

Yes

No
Degree type and major:



Qualifications


Please list all certifications here (Example: CNA, CPR, QMAP):


What languages other than English do you speak fluently?


When was your last T.B. Test?


Are you able to perform the following job duties? Please confirm either “able to do all job duties” or list any that you are NOT able to do. (This will not necessarily disqualify you from employment.)
Housekeeping (example: vacuum, sweep/mop, clean bathroom)
Preparing Meals
Household lifting (exmple: carrying groveries, laundry)
Assist with personal care (help with shower, incontinence)
Reposition client in bed
Assist client with mobility, standby assist
Assist with pivot transfer
Assist with full transfer
Transport clients in own car

Able to do all listed job duties:

Yes

No
Job duties I am not able to do:


Do you have a valid driver’s license?

Yes

No

Do you have access to a reliable car?

Yes

No

Is that car covered under liability insurance as required by law?

Yes

No

Name of Insurance Provider:


Employment History

Employer

Job Title

Duties

Phone

Dates of Employment

Reason for Leaving

Employer

Job Title

Duties

Phone

Dates of Employment

Reason for Leaving

Employer

JobTitle

Duties

Phone

Dates of Employment

Reason for Leaving


Professional References (Persons with whom you have worked in the past)


Name

Phone

Name

Phone

Name

Phone


In case of emergency, please contact:

Relationship:

Phone:

Statement Regarding Caregiving History, Waiver and Release of Information

I attest that I, the applicant, have never abused, neglected, sexually assaulted, exploited or deprived any person nor have I subjected any person to serious injury as a result of intentional or grossly negligent misconduct.

I certify that the facts contained in this application form and/or my resume are true and complete to the best of my knowledge, and understand that subsequent to any employment any such statement and/or answers are found false or that information has been omitted, such false statements or omissions will be just cause for the termination of my employment.

I empower you and your agents, to retrieve information from all personnel, education institutions, government agencies, companies, corporations, law enforcement agencies at the federal, state, or county, relating to my past activities, to supply any and all information concerning my background, and release the same from any liability resulting in providing such information. The Information received may include, but is not limited to academic, residential, achievement, job performance, attendance, litigation personal history, credit reports, driving history, disciplinary and convictions records. I authorize Homecare, Inc. to share information on me, including my employment record, background check, and TB test results, upon request of any client with whom I am scheduled.

By my signature below, I hereby release any individual or institution, including its officers, employees, or related personnel, both individually and collectively, from any liability for damages for whatever kind, which may at the time result to me, because of compliance with this authorization and request to release information or any attempt to comply with it. I understand that I may be required to successfully pass a drug screening test. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.

I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.
Please sign the application electronically by entering the MONTH and DAY of your birthday (MMDD) in this box. DO NOT ENTER THE YEAR.


Click here when complete.