Employment

Thank you for seeking employment with Visiting Angels.
Please complete the form below to be considered for a caregiver position.

Applicant Name*
Street Address*
City / State / Zip*
Email Address*
Daytime Phone*
Evening Phone*
Total # of hours desired per week
How far are you willing to travel?
Your expected hourly rate
What days are you willing to work? Wednesday
Thursday
Friday
Saturday
Are you willing to work one weekend a month? Yes No
What hours on those days?
Are you currently employed? Yes No FT PT
Do you have a driver's license? Yes No
Do you have any limitations with lifting? Yes No
If yes, please explain:
Have experience with personal care? Yes No
If yes, please explain:
What qualifications do you currently hold?
Do you have experience with the following:
Hoyer Lift Feeding Tubes
Gait Belts Hospice Care
Slide Boards Seizures
Oxygen Alzheimer’s/Dementia
Catheter Care Autism
If you marked yes to any of these items, please explain your experiences:
Have you ever been convicted of a felony or misdemeanor offense? Yes No
If yes, please explain:
How long ago was the offense?
*required fields