Home-help Application Form
Summary
Caribbean Home Help is an agency focused on delivering quality service to our clients. The form is required for our records..
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Address
*
Email Address
*
example@example.com
Phone Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
National ID Number
*
No dashes
Have you been vaccinated for COVID 19?
*
Please Select
Yes
Partial
No
Have you been arrested or convicted of a crime
*
Please Select
Yes
No
Please upload a copy of you vaccination card
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Choose a file
Snap shot from your phones is adequate
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of
What is your mode of transportation for work?
*
Please Select
Public Transportation
Own Car
Someone Else will Drive Me
How many years have in Housekeeping
Have you every taken care of the elderly before
*
Please Select
Yes
No
Back
Next
Qualifications and Experience
Please provide us with three professional references (cannot be friends or family)
Reference 1
*
First Name
Last Name
Reference Contact No.
*
Please enter a valid phone number.
Reference 2
*
First Name
Last Name
Reference Contact No.
*
Please enter a valid phone number.
Reference 3
*
First Name
Last Name
Reference Contact No.
*
Please enter a valid phone number.
Please List past job experience and years
What is your least favorite housekeeping task?
What is your favorite housekeeping task?
What challenges have you experienced as a housekeeper?
What would you do in a situation where a client is unsatisfied with your work?
What is your favorite housekeeping task?
List your References name and contact number
Upload a copy of your references letters if you have them
Browse Files
Drag and drop files here
Choose a file
Snap shot from your phones is adequate
Cancel
of
Please submit image of police certificate of Character
*
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Drag and drop files here
Choose a file
Snap shot from your phones is adequate
Cancel
of
Please submit a profile image(clearly showing your face)
*
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Drag and drop files here
Choose a file
Snap shot from your phones is adequate
Cancel
of
Signature
*
Today's Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: