Become a Caregiver Thank you for your interest in working with us! Caregivers are contracted to Sitters, LLC and referred to our clients for employment; this application helps us determine your qualifications. 2023 average caregiver pay: $14.50/hour Application Form "*" indicates required fields Name* First Last Email* Cell Phone Number*Cell Phone Carrier*Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Date of Birth* MM slash DD slash YYYY Social Security Number*Emergency Contact Name* First Last Emergency Contact Phone Number*How did you hear about us?*Select an OptionWord of MouthExisting CaregiverClientHospital/FacilityOtherName of Caregiver who recommended you*Are you a non-smoker?* Yes No Are you afraid of animals?* Yes No AvailabilityDo you prefer to work days or nights?* Days Nights Can you work every other weekend?* Yes No What is your availability to work on Mondays? Example: 7a-7p or 7p-7aAvailability*What is your availability to work on Tuesdays? Example: 7a-7p or 7p-7aAvailability*What is your availability to work on Wednesdays? Example: 7a-7p or 7p-7aAvailability*What is your availability to work on Thursdays? Example: 7a-7p or 7p-7aAvailability*What is your availability to work on Fridays? Example: 7a-7p or 7p-7aAvailability*What is your availability to work on Saturdays? Example: 7a-7p or 7p-7aAvailability*What is your availability to work on Sundays? Example: 7a-7p or 7p-7aAvailability*Employment HistoryCheck skills and certifications that apply* CNA CPR Feeding Tube Catheter Hoyer Lift Checking Blood Pressure Checking Blood Sugar Level Empty Colostomy Bag None of the above Previous caregiving place of work*How long did you work here?Do you currently work here?*YesNoPrevious caregiving place of work 2How long did you work here?Professional reference 1Name* First Last Phone*Professional reference 2Name First Last PhoneEmailThis field is for validation purposes and should be left unchanged.
