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Caregiver registration page

Welcome to Medic Dispatch! We’re thrilled you’re interested in joining our network of compassionate caregivers. To get started, please fill out this sheet with your information.

Please enable JavaScript in your browser to complete this form.

Credentials and Experience

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

City

State

Date of Birth *

Do you have a vallid caregiver certification? *

If yes, please specify the type of issuance *

How many years of experience do you have as a caregiver? *

• Are you CPR and First Aid certified? *

• Do you have experience with any specific conditions or needs (e.g., dementia, mobility assistance)? *

• If yes, please list them: *

Availability and Preferences:

• What are your preferred days and times to work?

• Are you open to working weekends or holidays?

• What is your minimum hourly rate expectation?

• Do you have a preferred geographic area you'd like to work in?

(City, State)

• Are you comfortable providing transportation for clients?

• Do you speak any additional languages fluently?

• If yes, please list them:

References:

• Please provide the names and contact information for two professional references who can speak to your experience and qualifications as a caregiver.

Background Check:

• Medic Dispatch requires all caregivers to undergo a background check for the safety of our clients. Are you willing to consent to a background check?

Once you have submitted this sheet, we will review your information and contact you to schedule an interview. If selected, you will complete our online training modules and onboarding process.

Thank you for your interest in Medic Dispatch! We look forward to hearing from you soon.

(+0023)-433-233-0234
medicdispatch@gmail.com

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