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Host Application Form

Thank you for taking the time to fill in our application form.
Please note: The 'Host' is the homeowner being cared for. Their contact details are for file use only and we will not contact him/her. 'Our Contact Person' will be you. You will be our 'Client'.

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Host: Key Information

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Thanks for submitting!

Our Contact Person

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Host Details

Position required
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Would you prefer your companion to be:
Please mark if you would NOT be happy for your companion to be:
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Host: Your Needs Assessment

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Host: Your Task Profile

Your expectations of duties. Please indicate duties below that may apply to your position:

Host: Now, About You

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Host: Your Home Environment

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Please indicate if you will provide your carer with:
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Upload File
Upload Signature