Caregiver Application | WellSky Personal Care

Thank you for your interest in working for our agency.

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

Applicant Information:

First Name*:

Middle Name*:

No Middle Name:

Preferred Name:

Last Name*:

Address*:

Address Line 2:

City*:

State*:

Postal Code*:

Mobile Phone*:

Email*:

Location:

Hours wanted weekly*:

Date Of Birth:

Additional Information:

Please tell us about your experience providing care to others. We want to hear about professional and personal experience including care provided to loved ones.

Please list an emergency contact including name, address, phone number(s) and relation.

How did you hear about us? Indeed or an employee? Somewhere else? Tell us! If current employee, please tell us who!

What is your availability? Days of the week? Hours of the Day?

Are you able to lift at least 25 pounds? Do you have any limitations?

Disclaimer:

I certify that all information provided in this application is true and complete. I understand that any misstatement or omission may result in disqualification or termination if hired. I also understand that Illinois requires all caregivers to complete a fingerprint background check and 8 hours of annual training, and I agree to comply with these requirements and all 1776 Home Care policies, which may be updated at the company's discretion.

Signature: