Caregiver Application Form

Direct Support Worker Application Form
This information will be treated confidentially by Accuro Homecare and will only be used for recruitment and selection purposes.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post Code
Email*
example@example.com
Phone Number*
how did you hear about us?*
Residential status*
Highest education*
Relevant Tertiary Qualifications*
How many years experience do you have in a similar position?*
YESNO
YESNO
YESNO
Vehicle Make and Model*
Enter the make and model of your vehicle
Number of seats your car has*
YESNO
To help us provide you with a more flexible employment how many hours would you like to work per week?*
How many days a week are you available?*
noWeekendsEveningsPartial WeekendsPartial Evenings
YESNO
Leave the premises as it will be a safety hazard to myselfEnquire with the client as to their welfareClean it up
Bedroom, bathroomKitchen, bathroomKitchen, bedroom
Politely ask the client not to swear at meAllow the client space to vent their frustration and politely enquire how they would like the problem fixedLeave the premises as it will be a safety hazard to myself
Throw out any rubbishInform the client it is a safety hazard as it is dangerous to step over itemsmove item out of the way to create a pathway
YESNO
YESNO
YESNO
YESNO
YESNO
Resume*

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Direct Support Worker Application Form