Caregiver Application

This application form is intended for use in evaluating your qualifications for employment through us. Due to the ever changing nature of the job, our Caregivers work as Self-Employed/Contract Employees with BEAMS (Only Live-In Caregivers are considered full-time employees). This means that the duration of their employment is contingent upon the duration of the contract that BEAMS hold with the client to whom the caregiver is assigned. Other factors that will affect the duration of the caregiver's employment including death of the person being cared for, change in circumstances such as moving to a nursing home, replacement of the caregiver upon request of the client or due to other factors such as illness, disciplinary actions etc. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated without regard to race, color, religion, sex, age, disability, or any other protected class status under applicable law. The provision of a recent testing for the presence of illegal drugs in your body may be required prior to recommendation for employment.

Download and Read Carefully the Caregiver Job Description Please Complete Caregiver Application Required Documents: The following documents are required for us to consider your application A photo ID or photograph Copies of your certifications, recommendations, resume, BDA Nurses Council Registration, Police Certificate and all other documents that you deem important

If you need help filling out this application form or for any phase of the process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.  Please read "Applicant Note” below.  Complete all pages of this application.  Application will be valid for 60 days. You may select "Save & Continue Later" if you choose not to complete the application in one sitting. An email will be sent to you with the link to continue completing this application. Click Next if you are ready to begin completing the application.

You may select "Save & Continue Later" if you choose not to complete the application in one sitting. An email will be sent to you with the link to continue completing this application.

Click Next if you are ready to begin completing the application.

Please give us the name and contact of at least one individual to call in the event of an emergency

Please select your availability and work preferences

Please tell us a little about your qualification and certifications and experiences as a caregiver

Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.

Please complete all three (3) references. Your application will not be considered unless three references are provided. Since we will contact these references, please notify them in advance. If we are unable to reach all 6 references, you will be asked to provide additional references.

You have three options to get your supporting documents to us: 1) upload here, 2) email 3) bring them to our office. Please select the option of your choice below.

If you are selected for a caregiver post, your payments will be made on a bi-weekly basis by direct deposit to your bank account. Please give us your bank account information below. Your information will be kept strictly confidential

I certify that I have read and understand the applicant note on page one (1) of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. i) I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my execution of a job. ii) I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information. iii) I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. iv) I release this company from any liability, which might result from making such investigations. v) I also understand that the use of illegal drugs is prohibited during my execution of a job. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during my execution of a job. vi) I understand that this application is not a contract of employment or an offer of employment with BEAMS. Should I be offered a job as a caregiver. vii) I understand that my status will be that of self-employed. viii) My ability to be offered a job is contingent upon confirmation of credentials and successful completion of drug test or criminal background check. ix) I also understand that if hired, regardless of any oral presentations to the contrary, the relationship between Bermuda Alzheimer’s & Memory Services, and myself is terminable at-will, so that both the company and I remain free to choose to end our work relationship at any time for any or no reason. Any changes in this relationship must be made in writing. x) I understand that while I am employed through BEAMS caregiver agency, that at no time should I discuss salary, payment, rates or initiate or entertain any financial discussions with the client/employer. All such discussions must be conducted between myself and BEAMS. I further understand that failure to comply with this can and will result in the immediate termination of my contract with BEAMS. Should my contract be terminated as a result of my noncompliance with this, I hereby release BEAMS of any liability. xi) I also understand that due to the nature of the business, no amount of work can be guaranteed. My signature below (Indicated by my full name) acknowledges that I have read, understand, and agree to the above disclosure.

Please sign this application below by typing your full name then enter the date