We apologize for the convenience however this application is currently undergoing and upgrade.  Please bare with us during this time.  To inquire about becoming an Elder Care Companion, please contact us directly by email or phone at (305) 932-5335.


Elder Care Companion Application
Name  
 *(required)
E-mail  
 *(required)
Address  
City  
State/Province  
Zip  
Country  
Daytime Phone     Ext.
Best Time to Call  
Evening Phone  
Best Time to Call  
1. When are you available to start work?
2. Years of Professional Elder Care Experience: 
3. Type of experience:
4. Name of most recent elder care reference (preferably of 1 year or more):
5. Reference Phone:   Ext.
Yes    No 6. Are you a high school graduate?
Yes    No 7. Are you a college graduate?
Yes    No 8. Do you drive a car?
Yes    No 9. Do you smoke?
Yes    No 10. Would you be willing to relocate to Florida?
Yes    No 11. Are you willing to commit to a one-year employment contract?
Yes    No 12. Are you willing to work in a home with pets?
Yes    No 13. Are you a U.S. citizen?
Yes    No 14. If not, are you a resident alien?
Interested in position (check all that apply):
Companion Nanny
Mother’s Helper Prepare Meals
Light Housework Complete Housework
Driving Running Errands
Live In Live Out
   

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