Employment Application :: Choice Care - Home Care & Referral Services

Dear Caregiver,

Thank you very much for your interest in ChoiceCare, Inc. As you know, the need for capable and experienced home health care providers continues to grow. We are committed to assisting qualified candidates, free of charge, in finding home care positions which match their skills and experience. Please respond to the following questions to expedite your application process.

Sincerely,

Regina Khurin, MA
Client Services Director

PERSONAL INFORMATION
First Name
Middle Initial
Last Name
E-Mail

Current Address
Street Address
Apartment
City
State
Zip Code

Telephone Numbers (Please include your Area Code)
Home Phone
Work Phone
Cell Phone

TRANSPORTATION
Do you have a driver's license?
Do you own a car?
Do you have auto insurance?

SKILLS
Which language(s) do you speak and understand?
Chinese		French
Italian		Russian
Spanish		Tagalog
Other

Work Experience
Do you have at least 2 years experience in home care in the last 5 years?

If not, are you currently certified in one of the following designations?
CPR		First Aid
HHA		CNA
RN		LVN
Medical Assistant
Other


Cooking Skills
Housekeeping Skills
Patient Transferring Skills

Please check off only types of people you have been caring for:
Acute/Terminal Care		AIDS
Arthritis		Non-Ambulatory
Bone Fracture		Semi-Ambulatory
Cancer		Companion
Colostomy		Dementia/Alzheimer's
Diabetes		Frail
Heart Condition		Hospice
Kidney/Dialysis		Paralysis
Parkinson's		Post-Operation
Rehab		Stroke
Incontinent
Other

Availability Schedule
	Mon.	Tue.	Wed.	Thu.	Fri.	Sat.	Sun.	Times:
Live In
Live Out (Days)
Live Out (Mornings)
Live Out (Afternoons)
Live Out (Evenings)
Live Out (Overnights)

Locations:
San Francisco		Daly City
South San Francisco		Colma/Brisbane
Pacifica		Millbrae
San Bruno		Burlingame
San Mateo		Foster City
Menlo Park		Redwood City
Belmont		Palo Alto
San Carlos
Other

For further information, please email us at jobs@choicecareforseniors.com, or call our caregiver hotline at (415) 665-2010.