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(786) 697-5234

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Monday - Friday

9:00 am – 5:00 pm

info@avhelpfulhands.com

Email

REGISTER AS AN WORKER

Please upload latest photo:(Maximum photo size 12mb)

Name:

Middle Name:

Last Name:

Birth Date:

Nationality:

How long have you been here?

Are you married?
YesNo

Do you have children?
NoYes

If so how old are them and who take care of them while youre working.

Add a curriculum summary (Optional): (Maximum file size 12mb)

Do you have any certificate?
NoYes

Add a certificate (Optional): (Maximum file size 12mb)

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ADDRESS

CURRENT ADDRESS:

Street Address:

Street Address line 2:

Neighborhood:

City:

State/Province:

Postal/Zip Code:

1. PREVIOUS ADDRESS:

Street Address:

Street Address line 2:

Neighborhood:

City:

State/Province:

Postal/Zip Code:

Country:

2. PREVIOUS ADDRESS:

Street Address:

Street Address line 2:

Neighborhood:

City:

State/Province:

Postal/Zip Code:

Country:

Have you ever lived in another state in this country? Provide year and full address.

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Phone Number:

Email:

Confirm Email:

How many years’ experience do you have in this role?

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EMERGENCY CONTACT:
Name:

Relationship:

Phone Number:

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How did he find out about us?
FacebookInstagramGoogleReference from a friend

Tell me about yourself:

Briefly describe your childcare experience:

What day can you work?
Monday - FridaySaturdaysSundaysOvernightsEveningsOther

Describe:

Can you travel?
YesNo

Select all that apply:
Inside countryOutside country

Would you like to travel?
NoWeekends only1 or 2 weeks maximumUp to 1 month at a timeUp to 6 months at a timeUp to 1 year or more

What is your method of transportation?
My own vehicleFriends and familyPublic transportationOther

Especify

How many hours per week do you want to work?

How would you like to work?
Part timeFull timeTemporaryLong TermVacations TripsMomentary substituteOther

Describe:

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PERSONAL REFERENCES
REFERENCE 1:
Full Name:

Email:

Phone number:

REFERENCE 2:
Full Name:

Email:

Phone number:

REFERENCE 3:
Full Name:

Email:

Phone number:

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Have you used any names other than what is listed on this application?
YesNo

Have you been convicted of a misdemeanor and/or felony in the past 7 years?
YesNoStill pending

Do you have any speeding tickets, accidents, suspensions or DUIs in the last 3 years? (check all that apply)
Speeding ticket/sAccident/sSuspension/sDUINone of the above

LABOR REFERENCES:
You could mention the last 3 previous jobs, indicate the name of the boss, the
full address (Street, city, state, name of neighborhood.)

REFERENCE 1

Title:

Briefly describe your activities:

Boss's name:

Boss's Phone number:

Address:

Start Date:

End Date:

Indicate hourly wage:

Reason for leaving:

REFERENCE 2
Title:

Briefly describe your activities:

Boss's name:

Boss's Phone number:

Address:

Start Date:

End Date:

Indicate hourly wage:

Reason for leaving:

REFERENCE 3
Title:

Briefly describe your activities:

Boss's name:

Boss's Phone number:

Address:

Start Date:

End Date:

Indicate hourly wage:

Reason for leaving:

NOTE: MAY WE CONTACT THEM TO VERIFY THIS INFORMATION?(DESCRIBE YOUR ANSWER)

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THIS SECTION JUST WILL BE ANSWER ACCORDING OF YOUR POSITION OR ROLE:

Do you agree to work with the parents at home?
YesNoNo apply (Handyman, driver, gardener, other...)

Do you know swimming?
YesNoNo apply (Handyman, driver, gardener, other...)

Choose what would you like to be?
Living inLiving outNo apply (Handyman, driver, gardener, other...)

Do you smoke?
YesNo

Do you have experience with special needs children?
YesNoNo apply (Handyman, driver, gardener, other...)

Can you work with pets in the home?
DogCatBothNo petsNo apply (Handyman, driver, gardener, other...)

What task would you do at home?
DishesLaundryTidyingFamily meal prepChildren mealLight housekeepingOther

Describe:

Could you work providing oral medications to elderly people?
YesNoNo apply (Handyman, driver, gardener, other...)

Can you administer medications via injection?
YesNoNo apply (Handyman, driver, gardener, other...)

Describe if you have experience with people with Alzheimer's, disabilities or
any type of dementia?

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Thank you for contacting us ! We will contact you as soon as possible !

(786) 697-5234

Monday - Friday

info@avhelpfulhands.com

REGISTER AS AN WORKER

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