Apply for Lead Caregiver

Hello and thank you for your interest in Home Instead. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 442 Pleasant St, Blue Hill, ME 04614. Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at 207-404-2529. If you have any technical problems with this site please call 385-425-2195 for technical assistance.

Summary
Title:Lead Caregiver
ID:1101
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Application Information
* Requested Hours:
How many hours would you prefer to work weekly?
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Additional Information
* How did you hear about Home Instead?
If applicable, please specify:
US Key Player Application for Employment
APPLICANT NOTE
CAS Services is an independently owned and operated Home Instead® franchise 442 Pleasant St, Blue Hill, ME 04614 207-404-2529.

INSTRUCTIONS: If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.
  • Please read "Applicant Note” below.
  • Complete all pages off this application.
  • Print clearly. Incomplete or illegible applications may not be accepted.
  • If more space is needed to complete any question, use comments section on the back.
  • Application will be valid for 60 days.


Applicant Note: This application form is intended for use in evaluating your qualifications for employment with us , an independently owned and operated Home Instead franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.


PERSONAL INFORMATION
* Are you 19 years of age or older?
Yes   No
* Are you able to lift 25 pounds?
Yes   No
* Do you have reliable transportation?
Yes   No
* Have you ever submitted an application here before?
Yes   No
* You have been given a copy of the job description for the position for which you have applied. Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?
Yes   No

EDUCATION
Please check the highest grade level completed:

Grade School:
6   7   8
High School:
9   10   11   12
College:
13   14   15   16   16+

  Name City, State Major Subjects # Yrs Attended Graduate?
High School
*
*
*
*
Yes
No
Vocational/Technical
Yes
No
College/University
Yes
No


PROFESSIONAL EXPERIENCE
Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.


Most Recent Employer

Company Name City and State Company Phone
Dates Employed Job Title Supervisor Name
From:

To:
Duties
What did you like most about this position? Reason for Leaving


Second Most Recent Employer

Company Name City and State Company Phone
Dates Employed Job Title Supervisor Name
From:

To:
Duties
What did you like most about this position? Reason for Leaving


* Desired Compensation per___?
*

OTHER
* Describe any work history or training you've completed related to senior care and service:
* Describe any extracurricular activities/honors/awards.
* List any memberships in professional or job relevant organizations:


REFERENCES (Do not include relatives)
Please complete all four references (two professional/two personal). Your application will not be considered unless two references are provided. Since we will contact these references, please notify them in advance. .

Professional References
Full Name Phone Number Email Relationship Number of
Years
Known
*
*
*
*
*
*
*
*
*
*

Personal References
Full Name Phone Number Email Relationship Number of
Years
Known
*
*
*
*
*
*
*
*
*
*

CERTIFICATION
I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:
Follow-up questionnaire - caregiving experience
Follow-up questionnaire – caregiving experience
Please indicate those tasks in which you have experience. For the areas that you do not have experience, please note if you are willing to learn.

Tasks Experience
Yes/No
Willing to Learn
Companionship/Conversation
*
Yes   No
Meal Preparation (meals/snacks)
*
Yes   No
Housekeeping (dust, vacuum, laundry)
*
Yes   No
Bathing/showering Assistance
*
Yes   No
Dressing Assistance
*
Yes   No
Showering Assistance
*
Yes   No
Medication Reminders
*
Yes   No
Hospice Care
*
Yes   No
Stroke Care
*
Yes   No
Dementia Care
*
Yes   No
Incidental Transportation & Errands
*
Yes   No
Incontinence Care
*
Yes   No
Personal Care Assistance (Female)
*
Yes   No
Personal Care Assistance (Male)
*
Yes   No
Alzheimer’s or Dementia Care
*
Yes   No
Diabetes Care
*
Yes   No
Hearing Impairment
*
Yes   No
Transferring Assistance
(Example: helping a person from chair to standing position)
*
Yes   No
Ambulation Assistance
(Example: Ensure a person’s stability and safety when moving)
*
Yes   No
Mechanical Lift (Hoyer Lift)
*
Yes   No


* How many years of experience do you have as a caregiver?


Powered by ApplicantStack