Caregiver Application | WellSky Personal Care

Applicant Information:

First Name*:

Middle Name*:

No Middle Name:

Preferred Name:

Last Name*:

Address*:

Address Line 2:

City*:

State*:

Postal Code*:

Home Phone:

Mobile Phone*:

Email*:

Location:

Hours wanted weekly*:

Date Of Birth:

Education & Training:

High School

College

School:

Degree received:

Employment History:

Please provide your most recent positions of employment.

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

+ Add Additional Employer

Professional References:

Please provide professional references.

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

+ Add Additional Reference

Additional Information:

Are you 18 years of age?

Do you have a valid drivers license?

Do you have valid car insurance and reliable transportation?

Why do you want to work as a caregiver with Our Family Friend, LLC?

How did you hear about us? We like to thank those who refer wonderful people! Do you know any current or past Our Family Friend employees? If so, please list:

We service a large geographical area, which of these areas are you willing to work? Ann Arbor, Dexter, Chelsea, Saline, Stockbridge, Manchester, Grass Lake, Jackson, Spring Arbor, Hillsdale, and/or Lenawee County:

If you have any certifications (Certified Nursing Assistant - CNA, First Aid, etc) please specify those certifications below- *Not required for employment*:

Are you currently employed? Are you looking to supplement your current employment or work exclusively with Our Family Friend, LLC?

At Our Family Friend, LLC we love to recognize our employees. If you are offered employment with us we would like to know a bit about how you like to be recognized. Please answer the following questions: 1. Do you agree to be recognized publicly (social media, newsletters, etc.)? If yes, what is your Facebook profile name? 2. What are some of your favorite snacks, colors, hobbies, and animals? 3. What are your favorite kind of gift cards to receive? 4. Anything additional that would help us recognize you?

Clients are thoughtfully matched with caregivers based on availability, personality, and skillset to ensure the best possible fit. Please list all days and times you are available to work (for example: Monday–Friday mornings, weekends, evenings, etc.). Be as specific as possible.

What else would you like us to know about you that may not be captured in this application?

Disclaimer:

I understand that if I become an employee of Our Family Friend, LLC voluntarily. I understand and acknowledge that there is no specified length to my employment and that my employment is at will. I understand and acknowledge that "at will" means that I may terminate my employment at any time, with or without cause or advance notice. I also understand and acknowledge that "at will" means that Our Family Friend, LLC may terminate my employment at any time, with or without cause or advance notice, as long as they do not violate federal or state laws. I understand that it is my responsibility to read and comply with all policies included within the employee handbook. I further understand that I should consult my supervisor regarding any questions I may have. I understand that by signing this application, I am consenting to a background check and driving history check.

Signature:

Thank you for your interest in working for our agency.

Please submit the application below to be considered for a position as a caregiver.

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