Application for Employment

Are you interested in working for Optimal Caregivers? We are always looking for extra qualified caregivers and we are looking forward to meet you. We consider applicants for all positions without regard to race, color, creed, gender, national origin, age, marital status, or any other legally protected status.

Please fill in the form below or download the Application for Employment Form in .DOC or .PDF version. Please consider the following requirements upon interview: Drivers License / Identification, Social Security Card, Professional License, CPR Card, Car Insurance, Physical Exam, TB Test / Chest X-Ray Result.


How did you learn about Optimal Caregivers?

First Name (required)

Last Name (required)

Address (required)

City (required)

State (required)

Zip (required)

Telephone #

Mobile #

Email (required)

Best time to contact you at home is: AM PM 

If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No 

Have you ever filed an application with us before? Yes No 

Have you ever been employed by us before? Yes No 

Do any of your friends or relatives, other than your spouse, work here? Yes No 

If Yes, please state Name, Relationship and Department

Are you currently employed? Yes No 

Name of the Company

If Yes, may we contact your current employer? Yes No 

Are you prevented from lawfully becoming employed in this country because of Visa or Immigrant Status? Yes No 

Date available for work:

What is your desired salary range?

Are you available to work: Full time Part time Temporary 

Yes No 

Please indicate if AM PM 

Are you currently on "lay-off" status and subject to recall? Yes No 

Can you travel if the job requires it? Yes No 

 I understand I understand that by providing this information, I am not guaranteed employment.

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