Caution!

Visiting this web site requires a newer version of Netscape Communicator.

Visit Microsoft's Web site to obtain the newest version of Internet Explorer, or visit Netscape's Web site to obtain the newest version of Netscape Communicator.

Visiting this web site without first upgrading your browser may result in unreliable behavior.









Home Care, Home Health Agency, In home care, elderly care, elder care, home health provider, in home assisted living, Multnomah County, Clackamas County, Washington County
PO Box 16297
Portland, OR 97292-0297
Tel:503.760.1832
Fax: 503.760.7879
In-home care for the disabled and elderly
in Portland, Oregon, Multnomah, Clackamas and Washington County



Home


Client Profile


Client Rights


About Us

Disclosure



Important Info

Career Choices



Job Opportunities

Links



Great Resources



Home care, in home care, elder care, in home assisted living, caregivers, homecare provider, hospice care, Multnomah County, Clackamas County, Washington County, Oregon
Bonded Insured License # 15-2032

 





Please let us know how

can help

At Your Home Care, Inc., is always looking for honest caring individuals to work with our clients in an atmosphere of mutual respect.

Just as we assure our clients that our workers will treat them well, we expect our clients to show the same courtesy to our workers.

If you are the kind of person who wants to make a positive difference in the life of your client, we'd like to talk to you.

Just fill out the form below, and we'll give you a call.

Thanks for considering At Your Home Care, Inc.

                      About You
First Name *
 Last Name *
Your Address *
City *
 State *
 ZIP *
Home Phone *
 Work Phone
 Cell Phone
E-mail Address
Please Enter Your E-mail Address
How did you hear about At Your Home Care? *
Qwest   Verizon   Web  
Oregonian   Employment Paper   Friend/Co-Worker  
Other  
                     Training/Experience
1a. Are you a Certified Nursing Assistant (CNA)? *
Yes   No  
1b. Do you have CNA "Certificate of Completion"? *
Yes   No  
1c. Have you had 6 months experience supervised by an RN in a facility setting? (RCF, ALF, Nursing Home, or hospital)? *
Yes   No.  
1d. Do you have a high school diploma or GED? *
Yes.   No.  
                    Car/Drivers License
2. Do you have an Oregon or Washington Drivers License? *
Yes.   No.  
3a. Do you have a car? *
Yes.   No.  
3b. Is your car reliable? *
Yes.   No.  
Do you have car insurance? *
Yes.   No.  
                    Facility vs Home Care
4. Are you willing to travel to our clients' homes in Clackamas, Multnomah and Washington Counties? *
Yes   No.  
Will you work 3 hour shifts? Our shifts are a minimum of 3 hours in length *
Yes.   No.  
Mondays?
Yes.   No.  
Morning   Afternoon  
Evening   Sleepover  
Tuesdays?
Yes   No  
Morning   Afternoon  
Evening   Sleep-over  
Wednesday?
Yes   No  
Morning   Afternoon  
Evening   Sleep-Over  
Thursdays?
Yes   No  
Morning   Afternoon  
Evening   Sleep-Over  
Fridays?
Yes   No  
Morning   Afternoon  
Evening   Sleep-Over  
Saturday
Yes   No  
Morning   Afternoon  
Evening   Sleep-Over  
Sundays?
Yes   No  
Morning   Afternoon  
Evening   Sleep-Over  
                   Our Work Environment
7a. Will a criminal backgound check reveal any issues? *
Yes   No  
7b. Will a drug test reveal any issues? *
Yes   No  
7c. Will a driver's license report reveal any issues? *
Yes  
No  
Comments
Enter Additional Comments

* Required to submit this form













PO Box 16297
Portland, OR 97292-0297
Tel:503.760.1832
Fax: 503.760.7879

Caring is at the heart
of everything we do.

In-home care for the elderly and disabled
throughout Portland, Oregon, Multnomah, Clackamas and Washington County.

Home  |  Client Profile  |  Client Rights  |  About Us  |  Important Info  |  Job Opportunities  |  Great Resources



Sign In