Join, Country Gardens & The Townhouse

Name *

First

Last

Email *

State *

ZIP / Postal Code *

Phone *

Alternate Phone

What is the best way to contact you? *

Phone Text Email

Have you worked as a caregiver in the past? *

Yes No

If yes, select in which capacity you were a caregiver

Are you 21 or older? *

Yes No

Have you been issued or do you have an approved background check in accordance with OAR 411-049-0120 issued by Oregon Department of Human Services? *

Yes No

Do you have a current CPR and First Aid certification? *

Yes No

Have you completed any online training hosted by OregonCarePartners.com? *

Yes No

Have you been found guilty of or been issued a substanciated abuse charge? *

Yes No

Message / Tell us about yourself (previous work experience) *

Paste your resume here or type a short message to us telling us about your past expeience and why you would be a candidate

Please provide a minummu of your 3 professional references (previous work experience) *

Please include contact details and duration worked for each reference