Pre-Hire Caregiver Application - Caregiver Profile Applicant Name* First Last Position Applied For*Phone #1*Phone #2*Email* City*Cross Streets*Areas available for work* Work Availability Work Availability*Day of the weekHours AvailableNotes How much noticed needed before schedule?*1 Hour4 Hour8 Hour24 Hour48 Hour72 HourDo you have an insured vehicle or reliable transportation?*YesNoAre you available after hours?*YesNoAre you a smoker?*YesNoCan you work with a client that smokes?*YesNoCan you work with clients that has pets?*YesYesAre you able to lift?*YesNoDo you have experience with a Hoyer lift or gait belt for transfers?*YesNoI have reviewed the job description for the position which I am applying for and certify that I meet the minimum requirements. Additionally, I have reviewed the examples of immediate disqualifiers for consideration of employment and don't expect those disqualifiers or similar to affect my ability to be considered for employment. This iframe contains the logic required to handle Ajax powered Gravity Forms.