Lotta HM & Companion Services Inc.
Miami, FL 33157
Full Name *
Date of Birth
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Email *
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Position Applying For
Date Available to Start
Desired Schedule Full-TimePart-TimeLive-InAs Needed
Available Days MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Preferred Work Hours
Are you legally eligible to work in the US? YesNo
Do you have reliable transportation? YesNo
Have you ever been convicted of a felony? YesNo
If yes, please explain:
Experience providing companion services? YesNo
If yes, how many years?
Check all applicable experience: CompanionshipMeal PreparationLight HousekeepingTransportation AssistanceMedication RemindersDementia/Alzheimer’s SupportMobility AssistancePersonal Care Assistance
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Highest Level of Education High SchoolSome CollegeCollege DegreeOther
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