Use the following form to register and apply as an Elderly or Child Care Provider with Help Care and Beyond. Application form for HCaB Care Provider Candidates (CPC) Job Desired Preference 1:Job Desired Preference 2:PERSONAL DATA:Name First Last Nick Name or Other Names used in USADate of Birth* MM slash DD slash YYYY AgePresent Address* Street Address City 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 State ZIP Code Years at present address*Previous Address Street Address Address Line 2 City 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 State ZIP Code Years at previous address*Driver’s LicenseAny First Aid or CPR CertificateDaytime Phone Number*Email Educational AttainmentLanguages SpokenOther SkillsChildcare/Elderly Training or CertificatesMedical ConcernsHCaB CPC JOB SEARCH NEEDS:CPC Job Title Nanny Nanny Mother’s helper’ Nanny Housekeeper Elderly Sitter School Homework Helper Newborn Specialist Baby Sitter Summer Sitter Event Sitter Travel Sitter On Call Sitter Employment Situation Full Time Part Time Temporary Night Shift 24/7 Working Situation Live Out Live In Hours Needed per week 5-30 hours 30-50 hours Availability Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday Maximum Number of Children to Handle 1 1-2 1-3 1-4 Ages of Child Preference Newborn Toddler Early School Age School Age Teenage Ages of Elderly 50-60 60-70 80 90 General description of CPC’s qualifications for the job desired or preference indicated above.CPC WORK OR EXPERIENCE RELATED REFERENCESPrevious EmployerPrevious Employer Name First Last Previous Employer Email Present EmployerPresent Employer Name First Last Present Employer Email OTHER PERSONAL REFERENCESName First Last PhoneRelationName First Last PhoneRelationResumeUpload Your ResumeAccepted file types: doc, pdf, Max. file size: 512 MB.TERMS OF ACCEPTANCEHCaB does not charge Care Provider Candidates (CPC) any application fee. All application received on and off line will have to be evaluated thoroughly by HCaB Team Consultants, thereafter CPC will undergo immediate HCaB preliminary in depth face to face interviews, standard psychological screening tests and should agree to background check personal and work references. After which, CPC’s Profile will be submitted to the Family for the final interview or Work Trial Offer. HCaB makes every effort to match families and the CPC successfully. The Family will make the final employment decision and HCaB does not have the prerogative to control their decisions unless it is against the law and endangerment to the family. Also, if the CPC chooses to accept or not accept the employment, the CPC must notify HCaB immediately. Help Care and Beyond referral services and business transactions are all dealt with integrity, impartiality, professionalism, confidentiality and privacy. All Care Provider Candidates (CPC) information provided to us should be true correct nor create misleading statements to avoid disqualifications.TERMS OF ACCEPTANCE and SIGNATURE I, the applicant, warrant the truthfulness of the information provided in this application.Electronic Signature*Please type your First and Last NameAcknowledgement* I acknowledge agreement with our terms by checking this box.
