Apply Online with Visiting Angels

Applicant Information
Driver License State

Organization Telephone Contact Person Dates Worked May We Contact Ver
Contact Person Telephone Position/Title Dates Known Ver

Criminal History

Name Location Major Graduate? End Date
Name Location Graduate? End Date

The below time-frame is for hours NOT able to be worked.
Live-Ins - Being a Live-In means several consecutive days of care where the caregiver stays at the care recipient's home for the entire number of days.

Skills and Preferences

Specialized Training

Additional Questions

Emergency Contact Information
Name Relationship Cell Phone Home Phone

I certify the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentation of facts will result in rejection from this application and/or discharge at any time during employment period. I authorize Visiting Angels to verify any and all information contained within this application, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment. (During the first interview, each applicant will be asked to sign a form authorizing Visiting Angels to perform an extensive back ground check)

I agree not to do business directly with any individual or business entity that Visiting Angels has introduced to me or by entering into employment with such individuals or businesses.

I understand that I will provide home care services on a temporary and when needed only basis, with the understanding that our Agency will inform you on the earliest possible date the days that services are required. We cannot guarantee the number of hours you will receive therefore your hours may be zero at times. (Although Visiting Angels will attempt to provide as many hours as possible, this is a part-time at-will employment position)

I agree to NOT change/adjust the schedule with the client or their family, and I will direct ALL scheduling changes through the Visiting Angels office and direct ANY requests to the same.

I will not give out any personal information (i.e. phone number, address, or email) to any client or their family members, while they are an active client under my care or Visiting Angels care.

I will not transport any client without written permission and waivers signed and filed in the office. I will not take a client from their home without permission from the office, and notification of family by office staff. Failure to abide by this brings liability upon the Caregiver and could cause termination or reprimand by Visiting Angels.