General Caregiver Application

Which Serenity Location are you applying to?*
Which Serenity Branch are you applying for?
Which Serenity Branch are you applying for?
Which Serenity Branch are you applying for?
Which Serenity Branch are you applying for?
Which Serenity Branch are you applying for?
Which Serenity Branch are you applying for?
Which Serenity Branch are you applying for?
Full Name*
First Name Middle Name Last Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Date Available*
MM slash DD slash YYYY
Have you previously been employed with our organization?*
- Yes
- No
Are you authorized to work in the US?*
- Yes
- No
Are you a protected Veteran?*
This role requires that employees have a background check that meets state and federal regulations for working with vulnerable populations. Are you able to meet these regulatory requirements?*
- Yes
- No
(Note: A conviction will not necessarily disqualify you from employment.)
What is your primary language?*
What other languages do you speak?*
Highest Level of Education*
Do you have any Caregiving Experience?*
Do You Drive?*
- Yes
- No
If yes, can you provide:
- Valid Driver’s License
- Proof of Car Insurance
How did you hear about us?*
Please Specify
Select all applicable skills and preferences that reflect your experience and comfort level.
Client Care Experience
- Dementia Care Experience
- Hospice Care Experience
- Incontinence Care Experience
Mobility Assistance
- Experience with Transfers
- Gait Belt Experience
- Hoyer Lift Experience
Environmental Preferences
- Comfortable working in homes where clients smoke
- Comfortable around pets
Pets
- OK with Cats
- OK with Dogs
Certifications And Credentials
Please check all that apply
- Certified Nursing Assistant (CNA) License
- CPR Certification
- First Aid Certification
- Tuberculosis (TB) Test
- State ID Card
Other Skills and Qualifications
Please list any additional relevant skills, languages, or certifications:*
Previous Employment
Employer
Date Employed
Supervisor
Supervisor Phone Number
Company Address
Add More Employment History
- Yes
- No
Previous Employment
Employer
Date Employed
Supervisor
Supervisor Phone Number
Company Address
Add More Employment History
- Yes
- No
Previous Employment
Employer
Date Employed
Supervisor
Supervisor Phone Number
Company Address
Resume and Credentials
Upload your Resume*
Max. file size: 256 MB.
Upload your credentials
Drop files here or

Accepted file types: jpg, pdf, doc, Max. file size: 256 MB.
References
Please list one or more references (professional or personal) who can speak to your character, skills, or experience. Include their name, relationship to you, and contact information.
Name*
First Name Last Name
Relationship*
Phone Number*
Add Reference
- Yes
- No
References
Name
First Name Last Name
Relationship
Phone Number

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General Caregiver Application

Select all applicable skills and preferences that reflect your experience and comfort level.

Certifications And Credentials

Other Skills and Qualifications

Previous Employment

Previous Employment

Previous Employment

Resume and Credentials

References

References