Caregiver Quick App

First Name First Name is required

Last Name Last Name is required

Address Address is required

Address 2

City Field is required

Province

Postal Code Field is required

Email Address A valid email address is required.

Phone Number Field is required

Business Phone

Do you have experience working with seniors?

Yes

If yes, please provide some examples of your experience working with seniors

Do you have your own transportation?

Yes

Do you have a valid driver's license and car insurance?

Yes

How did you find us?

Comments (Please do not submit any confidential, sensitive, or medical-related information through this form.)

Certification is required.

I CERTIFY that the information contained in this application is correct to the best of my knowledge, and I understand that any misstatement or omission of information is grounds for ending the hiring process or dismissal from employment. I authorize verification of information provided on this application; and authorize the references listed above to give the applicable Senior Helpers’ franchisee all pertinent information concerning my previous employment; and release all parties from all liability for any damage that may result from furnishing the same to a Senior Helpers’ franchisee. I further agree that either I or any Senior Helpers’ franchisee may terminate my employment with or without cause and with or without prior notice, at any time. No representative of Senior Helpers or its franchisees other than an executive officer has the authority to enter into any agreement for employment for any specified period of time. I understand that I may be required to submit to a drug test in accordance with the applicable Senior Helpers’ franchisee’s drug testing policy.

By checking this box, I agree to the terms and conditions of this application.

Senior Helpers is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this depends solely on your qualifications.

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