Become an Independent Caregiver in Western New York

Interested in supporting individuals and families across Buffalo and Western New York? Tell us about your experience, qualifications, availability, and the types of care and support you are comfortable providing.

Independent Caregiver Interest Questionnaire

Please do not include sensitive information such as Social Security numbers, identification documents, medical records, or any other highly confidential information.

Contact Information

Tell Family Alliance of WNY how to reach you.

First Name (required)

Last Name (required)

Cell Phone (required)

Email (required)

Address

City (required)

State (required)

ZIP (required)

Caregiving Details

Share any certifications or professional caregiving background, such as CNA, HHA, PCA, nursing experience, or CPR/First Aid, along with your preferred pay arrangement.

Certifications

Expected Pay Rate

Pay Type (required)

Private PayAgency Pay

Availability & Travel

List the days you are available, then choose your typical start and end times. If your hours vary by day, include those details in the Days Available field.

Availability (Days and Times) (required)

Typical Start Time (EDT) (required)

Typical End Time (EDT) (required)

How far are you willing to travel? (required)

Do you have transportation? (required)

YesNo

References & Experience

Provide your references and describe your experience as a caregiver.

References (required)

Experience as a caregiver (required)

Resume: Please also send your resume to familyalliance2024@gmail.com.

By submitting this form, you allow Family Alliance of WNY to use the information you provide to respond to your inquiry and help explore independent caregiver connections with families. Please review our Privacy Policy.

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