First Name *

Last Name *

Phone *

Email *

City *

How did you hear about us? *

Preferred Contact Method *

SMS

Phone

Can You Pass a National Background/Fingerprint/Drug Screen Test? *

Yes

Are You a CNA? *

Yes

Do You Have 1-4+ Years as a CNA/ PCA? *

Yes

Do You Have Hoyer Lift Experience? *

Yes

Do You Willing to Work With Clients Who Require a High Level of Care (Bed Bound, Hoyer Lift, Multiple Diagnoses) *

Yes

Do You Have a Current TB Test Result/ Chest XRAY? *

Yes

Do You Have a Current CPR / 1st Aid Certification? *

Yes

Upload Your CPR/1st Aid Certification Below (OPTIONAL)

Do You Have Reliable Transportation To and From Work? *

Yes

Are You Willing To Travel 25+ Miles? *

Yes

Which Shift Are You Prefer? (Select All That Apply) *

Day Shifts

Night Shifts

Weekend Shifts

Please note that by filling out this form, you are authorizing Home Care Matters to contact you via phone call, text message or email for the purpose of discussing employment opportunities and staffing. This consent applies regardless of whether or not you are registered on any state or federal Do Not Call List. We value your privacy and will not share your information with any third parties except as necessary to fulfill your request. If at any time you wish to opt-out of receiving further communications from us, you may do so by contacting us directly. Please note that opting out may affect our ability to provide you with information about potential employment opportunities.

I Consent to be Contacted by Home Care Matters *

I Agree/Authorize/Consent

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