Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Home Address *

City *

ZIP Code *

Work Preferences

Preferred Work Location *

Employment Type *

Earliest Start Date *

Experience & Education

Years of Caregiving Experience *

Highest Education Level *

Do you have an HCA (Home Care Aide) Number?

Other Certifications & Licenses

Previous Caregiving Experience

Additional Information

Availability *

Transportation *

Why do you want to work as a caregiver? *

Required Documents

Driver's License (Front & Back) *

Please upload a clear photo of both sides of your driver's license. Accepted formats: JPG, PNG, PDF (Max 10MB)

Resume/CV

Accepted formats: PDF, DOC, DOCX (Max 5MB)

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Relationship *

I consent to a background check and drug screening as required for employment in home healthcare.

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false statements may result in disqualification from employment.

I authorize Blue Wave Home Care to contact me regarding this application and future employment opportunities.

Caregiver Application

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