Employment Inquiry Form

If you are the kind of individual who cares about helping others and would like to join our ever growing family of nurturing caregivers, please feel free to contact our Recruiting department at 888-844-4442, and select option 1. If you prefer to contact us by email, please complete the employment inquiry below and click the SEND button at the bottom of the form.

* Indicates mandatory field. Your inquiry may not be submitted electronically without this information.

Personal Information

* Last Name:	* First Name:	Salutation:
		Choose Mr. Ms. Mrs.
* Address:	* City:
* State:	* Zip Code:
Choose Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Home Phone:	Work Phone:
E-mail Address:	Cell Phone:

Position Information

* Position of Interest:

Companion/Homemaker Companion only Homemaker only Personal Care Live-in companion Any Other

If Other, Please specify:

* Requested Hourly Rate:

Hours Preferred: Any Day Evening Night

Have you ever been employed by Companions & Homemakers, Inc.? Yes No

Why do you want to work for Companions & Homemakers, Inc.?

How Did You Hear About Us?: Client Referral Caregiver Referral Television Radio Search Engine Magazine / Newspaper Agency Yellow pages Other

Please identify the referral source:

Companions & Homemakers is an equal opportunity employer and recruits and selects people solely on the basis of job related requirements without regard to age, race, color, sex, marital status, religion, national origin, veteran status or disability.

Enter the code shown above

More Info

Why Do I Need to Enter This Code? By entering the code you see in the box, you help us prevent automated registrations. This reduces system loads and ensures better performance of our services. If no image appears, please make sure your browser is set to display images and try again. If you are not sure what the code is, make your best guess. If you guess incorrectly, you will have an opportunity to enter a different code on the next screen. Visually impaired or blind users: please contact us for assistance.

*

     

  |    |    Share