Becoming a viable candidate to provide
care is a simple three step process:
Step One:
Fill out our online resume / intake form.
HIT THE SUBMIT BUTTON AT THE BOTTOM OF THIS PAGE

Step two:
You will be contacted after we receive your completed form for instructions on how to obtain a criminal background and drug screening test.

Step Three:
Mail completed background and drug test results to; Senior Care San Diego 4142 Bannock Ave, San Diego ca 92117 to be included into our database of professional caregivers so we may begin the process of obtaining you gainful employment.

Required Fields *
Your Personal Information
*First Name:
Middle Name:
*Last Name:
*Address:
*City:
*State:
*Zip Code:
*Phone:
Cell Phone:
Email Address:
 
General Questions
*American Citizenship? Yes   No
*Certifications:
CNA
HHA
LVN
HCP
RN
NONE
*Educational Experience:
*Care Providing Experience: (Years)
*Hours Available to Work:
*Days You CAN NOT work:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
*Do You Have A Current CPR Card? Yes   No
*Can Your Prepare Meals? Yes   No
*Do You Have Your Own Car? Yes   No
*Salary Desired (Per Shift):
   

*Patient Care Experience
Elderly Paraplegic
Infants Injury/Surgical Recovery
Children Rehabilitation
Alzheimer's Comatose
Multiple Sclerosis Physiological Disorders
Quadriplegic Cancer
   

*Care You Will NOT Provide
Elderly Paraplegic
Infants Injury/Surgical Recovery
Children Rehabilitation
Alzheimer's Comatose
Multiple Sclerosis Physiological Disorders
Quadriplegic Cancer
    Will Provide Any Care
   

*Areas You Are Willing To Work
North County Coronado Island
San Diego Metro Ramona
East County Fallbrook
South County Alpine
San Diego
Beach Communities
   

*Are you willing to do light household duties including cleaning and laundry?

Yes   No
*Do you have any physical limitations that would preclude you from performing the duties you have selected ? Yes   No
If answered yes above please explain below  
 
*Have you ever been convicted of a misdemeanor involving substance abuse, violence or sexual mis-conduct? Yes   No
*Have you ever been convicted of a felony? Yes   No
*Can you read, speak and write in English? Yes   No
 
Please list the names , relationship and contact information of three references
(other than family members)
*Name:
*Phone:
*How Know:
 
*Name:
*Phone:
*How Know:
 
*Name:
*Phone:
*How Know:
 
Previous Three Employers
*Name:
Address:
City:
State:
Zip Code:
*Phone:
 
*Name:
Address:
City:
State:
Zip Code:
*Phone:
 
*Name:
Address:
City:
State:
Zip Code:
*Phone:
 

*Do you declare under the penalty of perjury under the jurisdiction and the laws of the state of California that all of the information you have provided herein is true and correct.
Yes   No
 
Additional Questions or Comments



Completed background checks and drug test results can be mailed to:
Senior Care San Diego
4142 Bannock Ave
San Diego Ca 92117
 
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