Hollister Care Home

Assisted Living in Carmichael

Caregiver

by

    NOTE: This application cannot save your progress. Please give yourself adequate time to fill it out completely. If possible, form should be completed on a computer.

    Personal Information

    First Name*
    Last Name*
    Phone*
    Email*
    Address*
    Are you legal to work in the United States?
    Upload your driver's license or state issued ID

    Availability

    What nights are you available for NOC shift (8pm-6am)?

    Can you work swing shift Monday-Friday (2pm-8pm)?

    Can you work day shift Monday-Friday (8am-6pm)?

    Can you work early day shift Monday-Friday (6am-2pm)?

    Can you work weekend shift #1 (Saturday/Sunday 6am-6pm)?

    Can you work weekend shift #2 (Saturday/Sunday 8am-8pm)?

    We operate 24 hours a day 7 days a week, 365 days a year.

    Can you work Holidays (required)?
    Can you work during spring break/winter vacation?
    Do you have any responsibilities that would prevent you from working these shifts on a regular basis?

    Work History & Experience

    Have you worked as a caregiver before?
    How many people with dementia have you cared for?

    How many bedbound people have you cared for?

    How many people on hospice have you cared for?

    Where have you worked?

    Describe duties:

    Direct Care Skills

    Please assess your skills in the following areas
    Transfers:

    2 Person Transfers:

    Hoyer:

    Changes in Bed:

    Changes Standing:

    Toileting:

    Peri Care:

    Oral Care:

    Dressing:

    Assisted Showers:

    Bed Baths:

    Feeding:

    Passing Meds:

    Redirecting:

    Dealing with Behaviors:

    Engaging in Activities:

    Food Service Skills

    Please assess your skills in the following areas
    Following a Recipe:

    Judging How Much Food to Prepare:

    Following Food Safety Protocols:

    Puree Diets:

    Minced Moist Diets:

    Soft Chopped Diets:

    Sanitary Skills

    Please assess your skills in the following areas
    PPE Usage:

    Sanitizing Dishes:

    Cleaning Biological Matter:

    Sanitizing Surfaces:

    Maintaining Clean Environment:

    Making Beds:

    Doing Laundry:

    Personal Skills

    Please assess your skills in the following areas
    Multitasking:

    Verbal Communication:

    Written Communication:

    Finding Something to Do:

    Resolving Conflict:

    Able to Take Direction/Feedback from Coworkers:

    Show Up to Work on Time:

    Use Technology (Phone/Computer Apps):

    Certifications

    Please select current or previous certifications, if any

    Other Certifications:

    References

    Please enter name, contact info, and relationship for several references

    Statement of Interest

    Tell us why you are interested in working here.