AHCS Caregiver Application

CAREGIVER REQUIREMENTS

  • Valid Driver's License, reliable vehicle, and up-to-date insurance and registration.
  • CPR and First Aid Certification, recent TB Test, and Arizona Fingerprint Clearance Card.
  • 6 months of verifiable caregiving experience.
  • Ability to fluently communicate with clients in English.

If you meet these requirements, please fill out the application below.

BASIC INFORMATION



Male Female













CERTIFICATION


Yes No





Yes No

Yes No

Yes No

Do you have experience caring for any of the following?

Yes No
Yes No
Yes No
Yes No
Yes No




OTHER QUALIFICATIONS




Yes No





Yes No



Yes No

Yes No

Yes No



Yes No





Yes No

Yes No



YES NO

Many of our clients request non-smoking companions.
YES NO

YES NO

Yes No



PREVIOUS EMPLOYERS

Most Recent Employer

Yes No
Yes No













Hourly Weekly Monthly



Second Most Recent Employer













Hourly Weekly Monthly



Third Most Recent Employer













Hourly Weekly Monthly



AVAILABILITY



YES NO

YES NO





HOW DID YOU HEAR ABOUT US

Where did you hear about us?

MONSTER.COM
The Job Examiner
GOOGLE
Craigslist




SUBMIT APPLICATION

All of the above statements are true and I understand that Affordable Home Care Solutions, L.L.C will be doing a thorough background check and calling all references. I fully understand that any offer of employment is contingent upon the results of my background check and references.

If you agree to the statement above, click on the submit application button.