Welcome to Comfort Keepers
of Folsom, Roseville and Sacramento
Caregiver Summary Application
First Name:
Last Name:
Address Line 1:
Address Line 2:
City:
State: CA
Zip Code:
Home Phone:
Cell Phone:
eMail Address:
Re-enter eMail Address:
Check All Types
# Years Care Experience
# Years Family Experience
(Answer Yes/No for all Skills)
Personal Care Experience Y/N:
Home Care Experience Y/N:
Transfers
Showers & Baths
Toiletries
Hoyer Lifts
Companionship
Meals & Housekeeping
Transportation
Grooming
(Answer Yes/No for all Skills)
Certificates:
Facilities Experience (Y/N):
Schedule Availability:
(check all boxes you can work)
In Home
Nursing Home
Assisted Living
Hospice
Other
Home Health
CNA
CPR
First Aid
Do you speak any other languages ?
Check all Location Box(es) you can work in
Comfort Keepers performs a comprehesive Criminal and DMV Background check
on all new hires
Would you pass our background check ?
Do you have a valid Drivers License?
Do you have current Auto Insurance ?
Enter any Brief Comments
Copy and Paste your resume if you have one.
Thank you for your interest in Comfort Keepers
Once you complete this form and submit it, our HR Manager Kathy will call you within a few days to start our interview process.
Schedule Flexibility
How did you hear about Us?
Today's Date:
