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Caregiver Opportunities
Caregiver Jobs Opportunities Through Job Order Referrals
Independent Caregiver Application
Are you seeking caregiver opportunities in San Diego County? Are you that special kind of caregiver who loves working with the elderly in their homes and cherishes your independence? Do you want to be out from under the constant scrutiny and criticism that some home care company mangers love to grind you with?
Our clients are able to continue living in their own homes as long as possible because we create caregiver opportunities in San Diego County for professionals like YOU!
Our elderly clients and their families will welcome your help, and you will decide with them when you will work and how you will get the job done! As a caregiver referred by us, you can have a successful caregiving career while calling the shots yourself!
Qualifications: YOU will be a great fit for these opportunities if you have experience and references, a recent TB clearance and a clean criminal background. If you are already Trustline verified, that's a big plus! Most of our opportunities also require that you have a reliable car, proof of insurance for it and a good driving record. The pay is great and the clients appreciate you.
Apply today!
Please note:
- This is an application to be referred by Age Assistance In-Home Care Agency, Inc. to clients, to perform caregiving work for them. You are applying to work through Age Assistance In-Home Care Agency, Inc., for clients. You are not applying to be an employee of Age Assistance In-Home Care Agency, Inc..
- Fields marked with an * asterisk are required and must be completed.
- The last two fields at the bottom of the form MUST be filled in (your initials and the CAPTCHA)
Name and Contact Information
First Name
*
Last Name
*
Email
*
Home Phone
*
Mobile Phone
*
Ok to send text messages?
Yes
No
We have also owned other in-home care agencies, called A Servant's Heart Care Solutions and A Servant's Heart Senior Care. Have you ever been employed by one of those companies?
*
Yes
No
Home Street Address
Home City
*
Home State
Home Zip Code
How did you find out about us?
Source: Where did you hear about us?
Craigslist
Indeed.com
Other
If client, caregiver or other: please provide the name
Allergies
I am NOT allergic to anything that may affect my performance.
Yes
I AM allergic to some things and that MAY affect my performance.
Yes
If allergies may affect your performance, please list your allergies here:
Education
Education: select highest level of education that you have achieved.
High School
Associate Degree
Bachelor's Degree
Graduate Degree
Some College But Did Not Graduate
Other
Prefer Not to Answer
Professional Certificates and Licenses
CNA
Yes
CHHA
Yes
LVN
Yes
RN
Yes
Medical Assistant
Yes
Years of experience
Years of experience as paid caregiver for adults (but NOT IHSS)
Years of experience as IHSS caregiver
Years of experience as unpaid caregiver for adults (family, friends, volunteer, other)
Do you know how, and are you willing, to work with the following?
Alzheimer's and other dementia
Yes
Hospice patients
Yes
Incontinence care
Yes
Assisting with ambulation and transfers
Yes
Transporting clients in your vehicle
Yes
Work with clients who smoke
Yes
Using lifting equipment such as Hoyer lift
Yes
What sort of jobs will you accept?
Hourly jobs
Yes
Live-in jobs
Yes
Driving
I have a valid driving license
Yes
I have NOT gotten a ticket while driving during the past 12 months.
Yes
I have NOT been in an accident during the past 3 years
Yes
I have NEVER been convicted for DUI.
Yes
I have a car that I can use for driving clients, with proof of insurance and registration.
Yes
Criminal background
Criminal history
*
I have NEVER been convicted of a crime involving violence, dishonesty, or abuse of the elderly or children.
I HAVE been convicted of a crime involving violence, dishonesty, or abuse of the elderly or children.
If you HAVE been convicted of a crime involving violence, dishonesty, or abuse of the elderly or children, please provide the details.
Trustlline background checking registration: select whichever choice is correct.
I am already registered with Trustline.
I am NOT registered with Trustline, and I AM willing to register with Trustline.
I am NOT registered with Trustline, and I an NOT willing to register with Trustline.
TB Clearance
TB Clearance (Tuberculosis clearance): Select whichever one of the following is correct:
*
I HAVE had a TB clearance within the past 12 months and I CAN provide a copy of the clearance.
I HAVE had a TB clearance within the past 12 months but I CANNOT provide a copy of the clearance and I AM willing to get a new clearance.
I HAVE had a TB clearance within the past 12 months but I CANNOT provide a copy of the clearance and I am NOT willing to get a new clearance.
I have NOT had a TB clearance within the past 12 months and I AM willing to get one.
I have NOT had a TB clearance within the past 12 months and I am NOT willing to get one.
Clients With Pets
I CAN work with clients who have dogs.
Yes
I CAN work with clients who have cats.
Yes
I CAN work with clients who have birds.
Yes
Authorization to Work
Authorization to work: Select one of the following:
*
I am legally authorized to work in the United States.
I am NOT legally authorized to work in the United States.
Language Skills
English language skills: select one of the following
*
I AM able to read, write, speak and understand English clearly.
I am NOT able to read, write, speak and understand English clearly.
If you know other languages well, list them here:
Work History
Most Recent Employer
Name of most recent employer
*
Dates employed: from when to when?
*
Supervisor's name
*
Supervisor's phone number
*
May we contact?
*
Yes
No
Later
Job title
Hours worked per week
Pay rate
Reason for leaving
Second Most Recent Employer
Name of second most recent employer
Dates employed: from when to when?
Supervisor's name
Supervisor's phone number
May we contact?
Yes
No
Later
Job title
Hours worked per week
Pay rate
Reason for leaving
Third Most Recent Employer
Name of third most recent employer
Dates employed: from when to when?
Supervisor's name
Supervisor's phone number
May we contact?
Yes
No
Later
Job title
Hours worked per week
Reason for leaving
APPLICATION TERMS AND CONDITIONS
By applying to receive referrals for caregiving job order opportunities through Age Assistance In-Home Care Agency, Inc. (referred to herein as "Age Assistance"), I understand and agree with the following terms and conditions regarding my application:
After reviewing this application, Age Assistance may invite me to be interviewed in person. The decision whether or not to invite me to interview will be made by Age Assistance at its sole discretion.
If I successfully complete the entire application process including interview(s), background checks and other possible steps or processes, Age Assistance may elect to invite me to enter into a "Referral Agreement" between me and Age Assistance.
I will not be offered job orders for caregiver opportunities with clients by Age Assistance unless such a Referral Agreement exists between me and Age Assistance.
By itself, this application does not constitute a Referral Agreement.
I am not now and will not become an employee, partner, nor agent of, nor engaged in any joint venture with, Age Assistance.
Age Assistance will not deduct withholding taxes (Federal, State or Local) FICA (Social Security or Medicaid) or any other taxes and I will not be entitled to any benefits from Age Assistance including, but not limited to, any and all workers compensation benefits, paid vacation, or life insurance, benefits, pension retirement, profit sharing and/or any other benefits that would accrue to persons in an employee/employer relationship.
In no way is any “employee/employer” relationship created by this application.
I will be free to perform in-home services for other placement services or agencies and to secure other placements through my own efforts.
The information provided here is true and complete to the best of my knowledge.
The references I have listed here, and other people who know me, have my permission to provide objective information about my performance, characteristics of my work, and my work-related activities with them.
I swear under penalty of perjury that all of the information I have provided is true and correct and that I have not withheld information that was requested.
By submitting this application, I affirm that I have read and agree to all of the disclosures and conditions included in the on-line application.
Applicant's understanding and acceptance of the Application Terms and Conditions: If you agree with the Application Terms and Conditions above, please type your full name in this text field.
*
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