Become a Carer Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 5Full Name *Email Address *Phone Number *What city are you in *Please enter the city you currently live in.What's your address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryWhat's your country of birth *Date of Birth *Do you have the legal right to work in NZ? *YesNoNextInterests and Hobbies *List a few things you enjoy doing in your free time (e.g., sports, reading, traveling, cooking).When supporting a client, what feels most natural to you? *I enjoy chatting and building rapportI’m comfortable with a balance of chat and quietI’m happiest supporting quietly and respectfullyHow do you usually support people best? *I’m proactive and like to take initiativeI work best collaboratively, checking in as I goI prefer to support quietly and only step in when neededWhy do you want to work for us? *PreviousNext – Name you Which days can you work? *MondayTuesdayWednesdayThursdayFridaySaturdaySundayWhich times are you available? *Morning (AM)Afternoon (PM)Evening (PM)Overnight / SleepoverWhen could you start if work becomes available? *ASAPWithin 2-4 WeeksOver 1 MonthHow many years of industry experience do you have?0-1 years1-3 years3+ yearsWhich areas do you have experience in? *Dementia CareParkinsonsDaily Home CareOvernight SupportNurse Level CareRest Home CareMobility SupportPersonal CareDo you have Industry Qualifications? *YesNoDo you hold a First Aid Certificate? *YesNoIf yes, please list your Industry Qualifications?Do you hold a full driver’s licence? *YesNoDo you have vehicle insurance? *YesNoAre you comfortable working independently? *YesNoPreviousNextDetails of Referees (employer or personal) : Please give details of two referees whose consent has been obtained and who may be contacted for a confidential reference. Where possible, at least one referee should be able to give work-related information. Referees Referee 1 - Full Name *Referee 1 – Relationship to you *Referee 1 – Email Address *Referee 2 - Full Name *Referee 2 – Relationship to you *Referee 2 – Email Address *PreviousNextDeclaration I declare that all the information I have given is true and that any false or misleading information may result in termination of contract with HOME CARE SERVICES. I understand that all information provided by me will be held on a confidential basis and that my permission will be sought before any identifying personal details are released to a third party. I consent to HOME CARE SERVICES undertaking reference checks pursuant to my application for a specific employment position, and recognise that all conducted on a confidential basis, and that HOME CARE SERVICES has the right to maintain confidentiality of this information. I declare that all information provided by me to HOME CARE SERVICES in this Independent Contractor Application is true, accurate and complete and is not designed to mislead in any way. Declaration *I confirm that I have read and understood the statements in the declaration above.Single Line TextPreviousSubmit
