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Carepanions is always interested to meet individuals who may want to work with our clients who require non-medical Part Time, Full Time, Live-in or Come and Go individuals who want to provide caring companionship and helping assistance in a home environment. Please use the following form to tell us a little about yourself and the type of position you are seeking. Candidates must have legal United States work status and be fluent in English. Based on our recruiting needs, if your information fits what we are looking for, we will give you a call, and schedule an interview. Otherwise, we will keep your information on file for future reference.

Carepanions will verify your identity and performs a comprehensive background history including a criminal background check before you are assigned. This, of course, is for the protection of our clients. Thank you for your interest in The Home Care Company, Chicagoland's most trusted provider of non-medical caregivers, companions and home care services for seniors.

	* REQUIRED

FIRST NAME *		LAST NAME *

STREET ADDRESS *

CITY *		STATE *	ZIP *

HOW LONG AT THIS ADDRESS?	YEARS MONTHS

HOME PHONE *		CELL PHONE

EMAIL ADDRESS *


	ARE YOU AUTHORIZED TO WORK IN THE USA?

	WHAT IS THE HIGHEST GRADE YOU COMPLETED IN SCHOOL ?

	ARE YOU WORKING NOW?

	WHEN DID YOU LAST WORK?

	ALTHOUGH NOT REQUIRED, ARE YOU CNA CERTIFIED?


	POSITION DESIRED

	FULL OR PART-TIME?

	PLEASE LIST THE DAYS AND HOURS YOU ARE AVAILABLE TO WORK

	DO YOU HAVE A VALID DRIVER'S LICENSE?

	DRIVERS LICENSE NUMBER?

	ISSUING STATE?

	DO YOU OWN A CAR?

	WHAT IS YOUR SOCIAL SECURITY NUMBER?


	WHAT IS THE NAME AND ADDRESS OF YOUR CURRENT OR LAST EMPLOYER?

	EMPLOYER'S NAME


	ADDRESS, CITY, STATE AND ZIP


	TELEPHONE
	POSITION

	EMPLOYMENT DATES		TO

	WHAT WERE YOUR DUTIES AT THIS JOB?


	WHAT IS THE NAME AND ADDRESS OF YOUR PREVIOUS EMPLOYER?

	EMPLOYER'S NAME


	ADDRESS, CITY, STATE AND ZIP


	TELEPHONE
	POSITION

	EMPLOYMENT DATES		TO

	WHAT WERE YOUR DUTIES AT THIS JOB?


	WHAT IS THE NAME AND ADDRESS OF YOUR NEXT PREVIOUS EMPLOYER?

	EMPLOYER'S NAME


	ADDRESS, CITY, STATE AND ZIP


	TELEPHONE
	POSITION

	EMPLOYMENT DATES		TO

	WHAT WERE YOUR DUTIES AT THIS JOB?

PLEASE LIST YOUR OVERALL EXPERIENCES WITH THE ELDERLY / DISABLED


Carepanions will verify your identity and perform a comprehensive background history including a criminal background check before assignment. This, of course, is for the protection of our clients. Press the SUBMIT button only once. If the form sends successfully, you will receive a THANK YOU page. If not, it will direct you to TRY AGAIN. You may press the PRESS HERE TO SUBMIT button, now.

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