1. How do I become a caregiver in Los Angeles?

California state law mandates caregivers to have 10 Hours of Professional Caregiver Training. You can take the course to meet the California state law guidelines.

2. Do you need a license to be a caregiver in California?

There is no need for a license for privately paid caregivers in California.

3. Can Prime caregivers help me find employment as a caregiver?

Yes, Prime caregivers is a referral employment agency. You can fill out the form to schedule an appointment.

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Caregiver Registration

Home > Caregiver Registration

Thank you for your interest in becoming part of our database at Prime Caregivers. Please complete and submit this application so we can begin the process of matching you with a client.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date Of Birth//

Primary Phone *

Email *

Can Prime Caregivers contact you?

Yes, Prime Caregivers can contact me
No, Prime Caregivers may not contact me

Prime Caregivers is a Caregiving Referral agency. Contact will be for referral only. We do not directly employ any Caregivers.

Have you been employed by Prime Caregivers before?

Your preferred area of work?

Los Angeles County
Orange County
Riverside County
San Bernadino County

Checkboxes

Central Los Angeles
West Side/South Bay
San Fernando Valley
Long Beach/562
San Gabriel Valley/ Pasadena Area

Checkboxes

South Orange County
Anaheim
Garden Grove/ HB/ Seal Beach

How did you hear about Prime Caregivers?

Referral
Newspaper
Job Fair
Google Search
Facebook
Other

Other Source

Emergency Contact information:

List 2 individuals we can contact in case of an emergency

Emergency Contact *

Relationship *

Phone Number *

2nd Emergency Contact Name *

Relationship *

e.g., Spouse, Brother, Friend, etc.

Phone Number *

Work Preferences

Which position you are most interested in: *

Live- In Caregiver
Hourly Caregiver

How many days per week are you available to work?

How many hours per shift are you available?

4hrs
8hrs
12hrs
24hrs/live-in

What days and times are you available to work?

Monday - Day
Monday - Night
Tuesday - Day
Tuesday - Night
Wednesday - Day
Wednesday - Night
Thursday - Day
Thursday - Night
Friday - Day
Friday - Night
Saturday - Day
Saturday - Night
Sunday - Day
Sunday - Night
All/Any

Day (5am-5pm), Night (5pm- 5am),

Client Preferences

You prefer to work with?

Male Clients Only
Female Clients Only
Both

You prefer to work with?

One client
Multiple clients

Are you allergic to the following?

Cats
Dogs
Fragrances
Smoke/cigarettes

Other Allergies

Are you able to work in a “smoking” home?

Additional Information

Other languages spoken:

List other special skills or experiences that you have used or have come across in homecare?

For example: Sewing, beautician, barbering, gardening, cooking, singing, etc.

Driving and areas of work

Please select the areas where you are willing to work:

Do you drive?

How many miles are you willing to commute?

Will you be able to use a car to drive the ciient around?

Driving for the client usually increases hourly/live in pay

Certifications

Provide copies of certifications during the hiring process.

Are you certified for CPR?

Do you have First Aid training?

Are you currently certified as a:

Registered Caregiver
CNA
LVN
RN

Training and Education

High School

Field of study?

Did you graduate?

College or other Education

Field of Study?

Did you graduate?

Do you have Training related to Caregiving or Healthcare? If yes, please explain.

If yes, who hired you?

Caregiving Referral Agency
Direct Hire by Home Health Care Agency
Direct Hire by Client
other

Work Experience

Please list your most recent employers first

Employer or Patients name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name & Phone

Start Date

End Date

Position held

What was your schedule? Live In or Live out?

How many patients did you care for in a shift?

Duties and Responsibilities:

Reason for leaving:

Request for Reference Information Completed

Work Experience 2

Employer (Client's Name)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name & Phone

Start Date

End Date

Position held

Schedule

How many patients did you care for in a shift?

Duties and Responsibilities:

Reason for leaving

Request for Reference Information Completed

Upload Resume

I certify that everything In this application is true and to the best of my knowledge. *

Do you give Consent for Prime Caregivers to review and forward your application when a client is matched? *

Prime Caregivers is a Referral Agency. Prime Caregivers does not employ any Caregivers. All information obtained is stored in our secure database and will be matched to clients with no discrimination.

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Prime caregivers believes in lending the support and home care assistance to adults and seniors in Southern California to make lives better.

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