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CAREGIVERS APPLICATION FORM

Application Form

Personal Information

Please input your personal information

MANDATORY COMMUNICATION REQUIREMENTS:

Please be advised that if the information below is left blank, we will not be able to accept your application.

SOCIAL MEDIA PLAYS A VERY IMPORTANT PART IN OUR COMMUNICATION EFFORTS IN CONTACTING YOU. IF YOU DO NOT HAVE A SKYPE, FB MESSENGER, AND WHATSAPP, YOU MUST MAKE ONE AND LIST YOUR ACCOUNT NAME BELOW.

"Only winners can give all what it takes"

Education

(Please list the last two institutions you have attended)

Additional courses, training or apprenticeship (Give details, include any caregiver-related course taken at school, e.g. caregiving for elderly and disabled, including Dementia Alzheimer’s or Parkinson’s, etc.):

Additional courses, training or apprenticeship (Give details, include any caregiver-related course taken at school, e.g. caregiving for elderly and disabled, including Dementia Alzheimer’s or Parkinson’s, etc.):

Additional courses, training or apprenticeship (Give details, include any caregiver-related course taken at school, e.g. caregiving for elderly and disabled, including Dementia Alzheimer’s or Parkinson’s, etc.):

Additional courses, training or apprenticeship (Give details, include any caregiver-related course taken at school, e.g. caregiving for elderly and disabled, including Dementia Alzheimer’s or Parkinson’s, etc.):

Family Information

01. Please input your family information

02. Please input your family information

03. Please input your family information

04. Please input your family information

05. Please input your family information

Family Information

01. (include ALL sons and daughters, including ALL adopted and step-children.)

02. (include ALL sons and daughters, including ALL adopted and step-children.)

03. (include ALL sons and daughters, including ALL adopted and step-children.)

04. (include ALL sons and daughters, including ALL adopted and step-children.)

05. (include ALL sons and daughters, including ALL adopted and step-children.)

Family Information

01. (include ALL brothers and sisters, ALL half-bother and sister, and step-brother and sister.)

02. (include ALL brothers and sisters, ALL half-bother and sister, and step-brother and sister.)

03. (include ALL brothers and sisters, ALL half-bother and sister, and step-brother and sister.)

Employment History

01. (Please list your last three employers, starting with the most recent one)

02. (Please list your last three employers, starting with the most recent one)

03. (Please list your last three employers, starting with the most recent one)

Note: For any Caregiver experience listed above, please check all applicable types of business or patients:

Immigration Related Questions

If Yes, complete the following:

Please provide us with copies of all documents related to any U.S. immigration cases that you may have.

"Only winners can give all what it takes"

I, THE UNDERSIGNED, ACKNOWLEDGE AND AGREE THAT, UPON APPLYING FOR THE EMPLOYMENT-BASED IMMIGRATION PETITION PROGRAM IN THE USA, I MUST ABIDE BY ALL CONDITIONS EXPLAINED TO ME BY THE CONSULTANCY. I AM AWARE THAT I WILL BE ON STANDBY TO LEAVE ON THE ARRANGED DATE OF DEPARTURE AFTER IMMIGRANT VISA HAS BEEN ISSUED. I UNDERSTAND THAT IF I CANCEL MY APPLICATION FOR ANY REASON, NO MONEY CAN BE TRANSFERRED OR REFUNDED TO ME BY THE CONSULTANCY. I ALSO UNDERSTAND THAT I WAS NOT RECRUITED BUT I AM SEEKING THE ASSISTANCE TO PROCESS FOR MY MIGRATION PETITION TO THE USA UNDER EMPLOYMENT-BASED. I CERTIFY THAT THE FOREGOING INFORMATION THAT I HAVE PROVIDED IS TRUE AND CORRECT.

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