I am an experienced Companion

Full Name*

Phone Number*

Email Address*

City of Residence*

Are you legally authorized to work in the United States?*
YesNo

How many years of experience do you have working as a Companion?*
0 - 2 years2 - 5 years5 years or more

Please describe your most recent position (family, duration, responsibilities):*

What types of care have you provided? (select all that apply)
CompanionshipPersonal careDementia / Alzheimer’s supportMobility assistanceMeal preparationLight housekeepingTransportation / errandsOvernight care

What do you enjoy most about being a Companion?*

What would former families say are your strengths?*

CPR & First Aid Certified?*
YesNo

Are you willing to complete a background check?*
YesNo

Do you have a valid driver’s license?*
YesNo

Do you have a reliable vehicle?*
YesNo

When are you available to start?*

Preferred schedule:
Full-timePart-timeDaytimeOvernightWeekend

Are you open to:
Live-inLive-out

Are you currently working with another family?*
YesNo

Do you have the following?

- Resume: YesNo
- Letters of Recommendation: YesNo
- Three references from former families
(Home Health Care Agencies and Room & Board Facilities are accepted): YesNo
- Valid CPR & First Aid Certification: YesNo

Why would you be a great fit for Rainbow Companions?*

Is there anything else you would like us to know?

*Rainbow Companions operates under the umbrella of Rainbow Nannies.

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