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Find Help
Children
Center for Children and Youth
Clinical Services for Children and Teens
Parents Place
Jewish Baby Network
Child Training Institute
Israeli Department, Bayit Ba’Valley
Youth
Service & Events
Impact Year
Leadership Program
Scholarship & Loans
Peer Mental Health
Internships
Summer Internship Program
Career Exploration
Holocaust Education
Adults & Families
Counseling & Mental Health
Adoption
LGBTQ+ Services
Center for Children and Youth
Parents Place
Spiritual Care
Grief & Bereavement
Pregnancy & Infant Loss
Domestic Violence Prevention
Emergency Family Assistance
Nutrition Program
JFCS Food Banks
Seniors
Seniors At Home
Home Care
Center for Dementia Care
Palliative Care
Fiduciary Services
Spiritual Care
Grief & Bereavement
Holocaust Survivor Services
L’Chaim Health Center
Assisted Living
Multipurpose Senior Services Program (MSSP)
Care Management
Disabilities Services
Gary Shupin Independent Living Community
Shupin Social Club
Special Connections
PEERS® Social Skills Training
Independent Living Skills Program
Care Management
Counseling
Spiritual Care and Healing
Grief & Bereavement Counseling
Miscarriage & Baby Loss
Rabbinic Services
Jewish Chaplaincy Services serving Stanford Medicine
Emigres
RJen Community
Citizenship Services
Legal Assistance
L’Chaim Health Center
Ukraine Response Resources
Financial Assistance
Emergency Family Assistance
Educational Loans & Grants
JFCS Business and Professional Loans
Camp Scholarships
Education & Training
Holocaust Education
Teen Programs
Parenting
Aging
Child Training Institute
Teacher Workshops
JFCS New Leaders Fellowship
New Leaders Fellows 2024
New Leaders Fellows 2023
New Leaders Fellows 2022
New Leaders Fellows 2019 – 20
New Leaders Fellows 2018 – 19
Nominate a JFCS New Leaders Fellow
Young Adult Leadership Council
Give
Donate Online Now
Many Ways to Give
Gifts of Stock
Wire Transfer Instructions
Donor Advised Funds
Legacy Giving
Donate to JFCS Food Banks
Volunteer
Ways to Volunteer
Young Adult Programs
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About
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Caregiver Application Form
Contact Us
Caregiver Application Form
Seniors At Home - Job Application for Caregivers
Seniors At Home is a division of Jewish Family and Children's Services. Please fill out this form to apply for caregiver jobs.
Employment Application
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Email
*
Primary Phone
*
Secondary Phone
Have you worked for Seniors At Home/JFCS in the past?
Yes
No
What year?
Reason for Leaving
How did you hear about Seniors at Home?
Friend/Family Member
Newspaper
Flyer
Google Search
Referral or source name:
Work Preferences
Which position you are most interested in:
Live- In Attendant
Hourly Attendant
How many days per week are you available to work?
1
2
3
4
5
How many hours per shift are you available?
2hrs
4hrs
8hrs
12hrs
24hrs/live-in
Indicate as best as you can, the days and shifts you are available to work:
Monday - Day
Monday - PM
Monday - Nights
Tuesday - Day
Tuesday - PM
Tuesday - Nights
Wednesday - Day
Wednesday - PM
Wednesday - Nights
Thursday - Day
Thursday - PM
Thursday - Nights
Friday - Day
Friday - PM
Friday - Nights
Saturday - Day
Saturday - PM
Saturday - Nights
Sunday - Day
Sunday - PM
Sunday - Nights
Day (7am-3pm), PM (3pm- 11pm), and Nights (11pm- 7am)
Client Preferences
You prefer to work with?
Male Clients Only
Female Clients Only
Both
You prefer to work with?
Single clients only
Multiple clients
Are you allergic to the following?
Cats
Dogs
Fragrances
Smoke/cigarettes
Other Allergies
Are you able to work in a “smoking” home?
Yes
No
Additional Information
Other languages spoken:
List other special skills or experiences that you have used or have come across in homecare?
For example: Sewing, beautician, barbering, gardening, cooking, singing, etc.
Driving and areas of work
Please select the areas where you are willing to work:
San Francisco Area
San Francisco only
North Peninsula Area
South SF
Daly City
Pacifica
San Bruno
Hillsborough
Millbrae
Burlingame
San Mateo
Foster City
San Carlos
South Peninsula Area
Redwood City
Palo Alto
Menlo Pk
Sunnyvale
Sta. Clara
Mt. View
San Jose
Marin/Sonoma
Sausalito
Mill Valley
San Rafael
Tiburon
Novato
Kentfield
Ross
Fairfax
San Anselmo
Corte Madera
Larkspur
Greenbrae
Rohnert Park
Petaluma
Santa Rosa
Sebastopol
Sonoma
Windsor
Cotati
Penngrove
Oakmont
Healdsburg
Do you drive?
Yes
No
Do you have a valid driver’s license?
Yes
No
License Number
Are you willing to drive a client in your car?
Yes
No
Are you willing to drive a client’s car?
Yes
No
Can you provide proof of car insurance?
Yes
No
Certifications
Provide copies of certifications during the hiring process.
Are you certified for CPR?
Yes
No
Do you have First Aid training?
Yes
No
Are you currently certified as a:
CNA
CHHA
LVN
RN
Training and Education
Training and Education
School
Field of Study
Certificate/Degree
Work Experience
Please list your most recent employers first
Employer (Client’s Name)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Supervisor's Name & Phone
Start Date
End Date
Salary
Position held
Schedule
How many patients did you care for in a shift?
Duties and Responsibilities:
Reason for leaving:
Request for Reference Information Completed
Yes
No
Work Experience 2
Employer (Client's Name)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Supervisor's Name & Phone
Start Date
End Date
Salary
Position held
Schedule
How many patients did you care for in a shift?
Duties and Responsibilities:
Reason for leaving
Request for Reference Information Completed
Yes
No
Work Experience 3
Employer (Client's Name)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Supervisor's Name & Phone
Start Date
End Date
Salary
Position Held
Schedule
How many patients did you care for in a shift?
Duties and responsibilities
Request for reference information completed
Yes
No
Name
*
First
Last
I certify that all information given on this application is true and correct. I also understand that the Jewish Family and Children’s Services may make an investigation of my work and personal history, and I authorize all persons, schools, companies, corporations and law enforcement agencies to supply any information concerning my background and release them from any liability and responsibility arising from their doing so. I understand that any misrepresentation or omission of information will be sufficient cause for dismissal.
Phone
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Survey Response Form
What is your age?
*
30-49
50-64
65+
Do you have assets you want to give today?
*
Yes
No
Do you want to receive income for you or for a loved one?
*
Yes
No
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