Toll Free: 1-888-227-3205 When Someone You Love Needs Care Palm Beach County 561-483-4044 Broward County 954-427-6916 We'll see that it's delivered 24 hours a day by Highly-Qualified and Compassionate Personal CareGivers Employment Form Name: Email: Address 1: Address 2: City: State: Zip code: Phone Number: Second Phone Number Education High School:   Yes    No      City/State College:   Yes    No      City/State College:   Yes    No      City/State Special Skills or Courses Most caregiver positions require the caregiver to transport a client. Do you have dependable transportation?     Yes    No Discuss any training or experience working with the elderly: Have you ever been convicted of a felony, pled guilty or no contest to a felony?     Yes    No If yes, please provide details: What would you like most about working with the elderly? What would you like least about working with the elderly? What is the number of hours you would like to work?   What is the maximum number of hours you are willing to work?   Times you are available to work:   Times you are not available to work:   Additional comments:                      Home Our Services Find Resources Our Service Area Employment Site Map Privacy Policy Terms And Conditions Copyright © 2004, Affinity Home care. All rights reserved. Affinity