Job Inquires
Make a difference by providing one on one care in our clients homes.
Call us at 503.760.1832 or fill in the form below and we will contact you.

APPLICANT
Name:
(First Last)
Address:
City, State, Zip:
Contact Phone:
Email Address:
How did you hear about At Your Home Care, LLC?:
TRAINING / EXPERIENCE
Are you a Certified Nursing Assistant? Yes

No
Do you have a CNA “Certificate of Completion”? Yes

No
Have you had 6 months experience supervised by an RN in a facility setting? (RCF, ALF, Nursing Home, or hospital) Yes

No
Do you have a high school diploma or GED? Yes

No
CAR / DRIVERS LICENSE
Do you have an Oregon or Washington Drivers License? Yes

No
Do you have a car? Yes

No
Is your car reliable? Yes

No
Do you have car insurance? Yes

No
FACILITY vs HOME CARE
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 minimum of 3 hours in length) Yes

No
AVAILABILITY – Select all options that apply
Mondays
Yes – all hrs
Morning Afternoon Evening Sleep-over
No
Tuesdays
Yes – all hrs
Morning Afternoon Evening Sleep-over
No
Wednesdays
Yes – all hrs
Morning Afternoon Evening Sleep-over
No
Thursdays
Yes – all hrs
Morning Afternoon Evening Sleep-over
No
Fridays
Yes – all hrs
Morning Afternoon Evening Sleep over
No
Saturdays
Yes – all hrs
Morning Afternoon Evening Sleep-over
No
Sundays
Yes – all hrs
Morning Afternoon Evening Sleep-over
No
OUR WORK ENVIRONMENT
Will a criminal background check reveal any issues? If yes, please explain. Yes

No
Will a drug test reveal any issues? If yes, please explain. Yes

No
Will a driver’s license report reveal any issues? If yes, please explain. Yes

No
Job Position Request / Additional Comments: