Application - Home Care Matters

Pre-Screening Form- Jobs

Let's determine if we meet each other's work requirements.

Name*
First Last
Phone*
Email*
Zip Code*
ZIP Code
Minimum Hourly Rate Required?*
Do you have any physical limitations to lift, push, pull, or carry heavy objects? This is a requirement for our services in the event a client falls and needs immediate assistance from our team.*
Answer either YES OR NO
Do you have a valid driver's license? This is a requirement for our clients.*
Answer either YES OR NO
Do you have proof of auto insurance? This is a requirement for transporting our clients.*
Answer either YES OR NO
Do you have a current CNA license for the state of Georgia? If NO, the state of Georgia requires you take and pass a PCA exam which can be done in our office.*
Answer either YES OR NO
Do you have a current TB test? This is a requirement of the state. If not, please get this and call us after you have it in hand. We would love to work with you!*
Answer either YES OR NO
Do you have current, and required CPR and First Aid certifications? If not, please obtain and call us as soon as you have it! We would love to work with you!*
Answer either YES OR NO
Do you have at least 5 years of previous work experience as a CNA or PCA? This is a requirement for employment and will need to be validated.*
Answer either YES OR NO
What shift (s) are you seeking?*
- Select All
- Days
- Nights
- Weekends
Please specify the hours you are available to work. *Please use am and pm.*
How did you hear about us?*
Thank you for taking the time to complete each question. Please list below the best time of day for us to reach you. We are hopeful we meet your needs from an employer and will follow up if your availability and qualifications meet state requirements and the requirements of our clients. Have an awesome day and thank you again! Home Care Matters.*
List the best time of day to reach you.
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Photo of Driver's License, CPR card, TB, Certifications, Insurance etc.
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