Apply | Zephyr Cares

Apply to become a caregiver

First Name

Last Name

Email Address

Cell Phone Number

Street Address

City

State

Zip Code

Date available for work

Are you 18 years of age or older?

Have you lived in a different State within the last 2 years?

Have you ever been employed by us before?

How many hours a week do you prefer to work?

I understand I must complete required PA clearances before I am assigned to a consumer.

Do you have a valid driver's license?

Do you have an insured vehicle available for work related use?

Reference 1 — Name / Company (not a relative)

Reference 1 — Phone

Reference 1 — Relationship

Reference 2 — Name / Company (not a relative)

Reference 2 — Phone

Reference 2 — Relationship

Most recent employer — Company

Most recent employer — Job title

Experience helping others with daily activities (bathing, meals, mobility, etc.)

A client is due for a medication reminder and does not want to take their own pills. What do you do? Remember: we never give or administer medication. Reminders only

Why is it important to keep client information private?

What would you do if you saw a safety issue in a client's home?

Comfortable using a smartphone for clock-in and notes?

I consent to Zephyr contacting the references and employers listed here.

I certify that the answers given here are true and complete.

Print name (typed name is your signature)