Caregiver Application

Caregiver Application

We are always looking for caregivers. To be considered for a position please fill out the form below. After reviewing your application we will get back to you.

  • Applicants considered for hire will be subject to a thorough background screening process that includes a criminal background check and may include a motor vehicle check and drug screen. (Please note that some positions require you to be insured and bonded.)
  • High School/GED Background

  • College Background

  • Employement History

    List your last three (3) employers, assignments, or volunteer activities, starting with the most recent, including military experience.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • References

    List name and telephone number of three professional references that are NOT related to you. If not applicable, list three school or personal references that are not related to you, whom have knowledge of your work ethic, experience, and abilities.
  • By submitting this form I certify that the facts contained in this application and/or interview(s) are true and complete. Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date.
  • I understand that, if employed, my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without notice. No representative of Customized Care other than the owner(s) is authorized to make any assurance or promise of continued employment and any such assurance must be in writing signed by the owner(s).
  • The employer, Customized Care, is an Equal Opportunity Employer. The employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law.