Supportive Caregiving

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    * fields are REQUIRED

    First Name*

    Last Name*

    Your Email*

    Home Phone*

    Cell Phone

    Work Phone

    What is the best time to call?:*

    DaysEvenings

    I am applying for the following position(s):* (Please check all that apply)

    M-F MORNING ATTENDANT: Usually from 5:30am to approximately10:30am – (Requires LPN or CNA certification)WEEKEND MORNING ATTENDANT: Usually from 5:30am to approximately 10:30am (Requires LPN or CNA certification)EVENING CAREGIVER: 3-4 evenings/week, 2-hour shifts; flexible schedule, between approx. 6:30pm and approx. 9:30pm

    I have a valid Arizona Driver’s License.*

    YesNo

    I have a vehicle regularly available to me to run errands during the course of the work day.*

    YesNo

    I hold a current CPR certification.*

    YesNoNo. If offered a position, I will obtain CPR certification prior to my first day of employment.

    I have been tested for tuberculosis.* Proof of tuberculosis testing is REQUIRED for all Morning Attendant positions.

    YesNoNo. If offered a position, I will obtain a tuberculosis test prior to my first day of employment.

    I have an FBI fingerprint record on file.*

    YesNoNo. If offered a position, I am willing to have my fingerprints placed on file with the FBI.

    Please indicate which certifications you have obtained and currently hold.* Please check all that apply.

    RNLPNCNACaregiverNone of the above, but I am willing to be trained for the evening position.

    Please explain why you are a good candidate for the position(s) you are seeking.*
    Please include all relevant work history, education, personal interests and life experience that make you well-suited for the position you are seeking. Please do not paste your resume or references here. You will have the opportunity to send us your resume / references once you receive our confirmation email.