Comfort Keepers of Solano County Employment Application

Carefully and accurately fill out all fields. When ready, click "Submit" below.
1. How did you hear about this position?
2. How many hours per week are you looking to work?
3. Do you have professional caregiving experience?
Yes No
4. Do you have family experience caregiving?
Yes No
5. Do you have experience and/or training in Personal Care? (ex: transferring, bathing assistance, incontience care, etc.)
Yes No
6. Do you have experience with Alzheimer's/dementia?
Yes No
7. Do you have experience with Hospice care?
Yes No
8. Please explain your caregiving experience:
9. Have you ever worked for Comfort Keepers?
Yes No
10. Where and when?
11. List your last employer, assignment or volunteer activity
12. Describe that position
13. List your second last employer, assignment or volunteer activity
14. Describe that postion
15. List your third last employer, assignment or volunteer activity
16. Describe that position
17. Do you have a valid drivers license?
Yes No
18. Do you have a reliable car that you can provide incidental transportation for clients in?
Yes No
19. Do you have current auto insurance in your name?
Yes No
20. What days and hours are you available to work for Comfort Keepers? (Availability must be honored for at least 3 months)
21. Are you willing to work in Vallejo?
Yes No
22. Are you willing to work in Benicia?
Yes No
23. Are you willing to work in Suisun City?
Yes No
24. Are you willing to work in Fairfield?
Yes No
25. Are you willing to work in Vacaville?
Yes No
26. Are you willing to work in Winters?
Yes No
27. Are you willing to work in Rio Vista?
Yes No
28. Are you able to pass a criminal background and DMV check? (including DUI's)
Yes No
29. Are you able to pass a health screening and drug testing?
Yes No
30. Do you speak any other languages?
Yes No
31. If so, please list:
32. Please list any certifications. (ex: CNA, CPR, LifeScan, First Aid, etc.)
33. Are you comfortable working with pets in the clients' home?
Yes No