Thank you for your interest in working for our agency.

Please submit the application below to be considered for a position as a caregiver.

Applicant Information:
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Skills:
Caregiver can manage clients with the following requirements:

Level 1

Level 2

Level 3

Education & Training:
Certifications and Credentials:
Please check all that apply, and enter the expiration date and any notes as applicable.
Active Type Expiration Date Notes
Car Insurance
CNA License
COVID-19 Vaccine
CPR Certification
Driver's License
First Aid Certification
HCA Reg
HHA Certification
LVN/LPN Certification
Performance Evaluation
State ID Card
Tuberculosis Test

+ Add Additional Certification or Credential

Employment History:
Please provide your most recent positions of employment.

+ Add Additional Employer

Professional References:
Please provide professional references.

+ Add Additional Reference

Additional Information:
Disclaimer:
By submitting this application, I certify that all information I have provided is true, complete, and accurate to the best of my knowledge. I understand that any false, misleading, or omitted information may disqualify me from further consideration for employment, or if discovered after hire, may result in disciplinary action up to and including termination. I understand that Peggy’s Home Care complies with all applicable federal, state, and local laws, including California laws governing privacy, background checks, consumer reports, and fair hiring practices. I acknowledge the following: At‑Will Employment: If hired, my employment will be on an at‑will basis as permitted under California law, meaning either I or Peggy’s Home Care may end the employment relationship at any time, with or without cause or notice. Reference & Credential Verification: Peggy’s Home Care may verify the information I provided, including employment history and professional credentials or certifications that are required for the position. Background Screening: I understand that any post‑offer background checks (including criminal background checks) will be conducted only in compliance with California law, including required notices, written authorization, and individualized assessment procedures. Passing a background screen is not required to submit an application. No Guaranteed Offer: Submitting an application does not guarantee employment, interview selection, or job placement. Privacy Notice: I acknowledge that any personal information collected during this application process will be used solely for employment consideration and processed in accordance with the California Consumer Privacy Act (CCPA) and Peggy’s Home Care policies. By clicking “Submit,” I affirm that I have read, understood, and agree to the above statements.
Signature:

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Date:

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New ID:

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Paid By*:

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