For Caregivers

Caregiver Intake Form

Share your experience, services, availability, and pay preferences. We'll match you with families hiring directly — no agency middleman.

Caregiver eligibility checklist

Before you submit, make sure you can check most of these boxes. It's how we keep families and caregivers safe:

You're 18 or older and legally authorized to work in the United States.
You have a current CPR & First Aid card (or will complete one before your first placement).
You can pass a background check and provide verifiable references.
You work as an independent contractor and handle your own taxes and scheduling.
You can serve clients in Los Angeles County, San Bernardino County, or nearby areas.
If you're an HCA-registered aide, you can provide your registry number and documentation.

Not sure if you qualify? Submit the form anyway — our team will review and point you in the right direction.

Your contact details

Full name *

Email *

Phone

City

County you want to work in *

How far will you travel?

Experience & work preferencesServices you offer *Select all that apply.

Your availabilitySelect all that apply.

CertificationsCPR & First Aid verification is required before placement.

Languages you speak

Years of experience

Desired hourly rate

When can you start?

Do you have reliable transportation?

Anything else you'd like families to know?

Supporting documents (optional)

You may attach your CPR & First Aid card, HCA registry proof, certifications, or a photo ID. PDF, JPG, PNG or WEBP, up to 5 MB each.

Document type

Uploading documents is optional — you can send them later by email.

Consent & privacy notice

We use your contact details, experience, and availability only to match you with families hiring directly and to follow up about your application.
Your profile details may be shown to families searching for care. Certification documents are stored privately and reviewed only by our staff.
You are an independent contractor. Verified CPR & First Aid is required before placement.
We never sell your information. You can ask us to update or delete your submission anytime by emailing aplacetoconnectla@gmail.com.
Your unfinished form is autosaved in this browser only so you can resume later. Choose “Start over” on a shared computer to erase it.

I have read and agree to this notice. * I consent to A Place to Connect storing and using the information I provide as described above, and to being contacted by email, phone, or text about my request. See our Terms & Privacy.

Caregiver FAQs — answered before you submit

Does it cost anything to join?

No. Creating a caregiver profile and applying to family care requests is free. You set your own hourly rate and are paid directly by the family.

Do I need a CPR & First Aid card?

Yes. An active CPR & First Aid certification is required before you can be matched or start a placement. If you don't have one, we'll send you a training link — use code CPR-ConnectCPR for a discount.

Do I need to be HCA registered?

It's not required to submit an intake form, but registered Home Care Aides get a verified badge and are prioritized by many families. You can add your registry number and upload documentation from your caregiver portal.

Am I an employee?

No. Caregivers work as independent contractors. You choose which families to work with, set your own rates and availability, and handle your own taxes.

How do families find me?

Once your profile is reviewed and published, families searching in your area can view your experience, services, and availability, and message you directly. You can also express interest in open care requests.

How soon can I start working?

After we review your intake form (1–2 business days), you'll finish your profile, verify your CPR card, and agree to our caregiver terms. Most caregivers are visible to families within a week.