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Online Care Intake
Care Details
Basic Care Needs (select all that apply)pick one!
Skilled Care Needs (select all that apply)pick one!
Expert Care Needspick one!
Schedule for Care
Days Needing Carepick one!
Contact Info
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Love Right Registration Application
Fill out every field and submit to be considered for an interview*
Personal Info

What Languages do you speak?

Worked under a different name?
Education & Training
Check all that apply*
Education Type
Work References

Please provide work history information (references)for 3 PROFESSIONAL positions you have held in the Elder Care / Hospital / Facility or Agency field ONLY.  (DO NOT list unrelated industry positions or jobs like 'Teller' or 'Cashier'). 

 

**helping your family members will not be considered as adequate experience

**must be professional paid experience

1.

Please check all boxes that apply to the work experiences you received from this employer.

Experience Level 1
Experience Level 2
Experience Level 3
May we contact this employer?

**You will be asked to provide additional work references if we can't contact this employer

**Remember, to be considered for an interview you must have a minimum of 3 employment references, private care and IHSS are ok.

2.

Please check all boxes that apply to the work experiences you received from this employer.

Experience Level 1
Experience Level 2
Experience Level 3
May we contact this employer?

**You will be asked to provide additional work references if we can't contact this employer

**Remember, to be considered for an interview you must have a minimum of 3 employment references, private care and IHSS are ok.

3.

Please check all boxes that apply to the work experiences you received from this employer.

Experience Level 1
Experience Level 2
Experience Level 3
May we contact this employer?

**You will be asked to provide additional work references if we can't contact this employer

**Remember, to be considered for an interview you must have a minimum of 3 employment references, private care and IHSS are ok.

Do you currently have ads offering private caregiving services to the general public?If so, Awesome! Let us know which ones.

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Stop Now.  In order to take advantage of our unique platform you must to keep your private ads running.  You will not be able to submit application if your answer is "NONE."
Personal References

Do not list family or previous supervisors

***Please do NOT duplicate names and numbers from your professional references listed above.

Availability & Travel

When and where you want to go

Available Days
Almost There, We Promise

Just a few more details

How would you rate yourself on experience with the following aspects of caregiving?  (optional)

CompanionshipRate Yourself
Meal PreparationRate Yourself
Light HouskeepingRate Yourself
Bathing / ShoweringRate Yourself
Dressing / GroomingRate Yourself
TransferringRate Yourself
Incontinence CareRate Yourself
Dementia / Alzheimer'sRate Yourself
Check all Supplies and Equipment You own that you use for Private Care Services

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Stop Now.  In order to take advantage of our unique platform you must supply your own equipment, similar to what's listed above.  You will not be able to submit application if your answer is "NONE."

*Registering as an independent domestic worker might not be what you're looking for.  Please visit our website at loverightcare.com/apply and check out the Registration info to find out if registering with Love Right is right for you.  Not ALL listed equiptment & supplies are necessary to be considered for registration. 

I certify that all answers given by me are true, accurate and complete.


I authorize investigation of all statements contained in this application, providing a urine sample for a drug test and for a background check to be completed.  I understand that misrepresentation or omission of facts in this application may be cause for invalidating my contract referral agreement with Love Right Home Care Referral Agency.  


I hereby release any and all prior employers or current employers from liability or claims arising out of the provision of information about my employment with such employer.  I hereby waive any cause of action I might otherwise have against such employer arising out of provision of information concerning my employment.  

You must accept the above statement before proceeding to submit the registration application.  If you have questions concerning drug tests, background check and further requirements please visit our website.  loverightcare.com/apply  You will be able to read many of the frequently asked questions that Independent Domestic Caregiver prospects ask.  Or feel free to call our office at 619-819-8780 and we can explain it to you.  Cheers!

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