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Career Form

Personal Information

Full Name

Phone Number

Email

Home Address

Address Line 1

City

State

Zip Code

Country

Date of Birth

Work Eligibility

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Are you legally authorized to work in the U.S.?

Can you pass a background check?

Position You are Applying for

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Please Select at Least one position you are applying for

Work Time

Start Date

Do you have caregiving experience?

Years of Experience

Types of care provided

Personal Care (bathing, grooming, dressing)

Light Housekeeping

Companionship

Transportation /Errands

Mobility Assistance

Skills & Qualities

Patient & compassionate

Reliable & punctual

Good communication

Experience with elderly clients

Experience with dementia clients

Certifications

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CPR/First Aid

Driver’s License

Reliable transportation

Auto insurance

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Availability

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Days Available

Mondays

Tuesdays

Wednessdays

Thursdays

Fridays

Saturdays

Sundays

Shift Preference

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Overnight

Background Check Consent

Please lets us know if you accept; we do a background check on you

I understand that Teeba Home Care is a non-medical agency and I consent to a criminal background check as part of the hiring process.

Work History

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Previous Employer

Job title

Duties

Emergency Contact

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Full Name

Relationship

Phone Number of Emergency Contact

Final Agreement

Digital Signature

Date Signed

Contact Us

Phone: 734-828-4039 | 734-828-4032

Email: teebahomecare@gmail.com

Address: 2081 Stockmeyer blvd Westland, MI 48186

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Phone: 734-828-4039 | 734-828-4032

Email: teebahomecare@gmail.com

Address: USA

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How To Protect Seniors From Falls

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