Care Counsellor Candidate Profile

Tell us about yourself

This form takes 25–30 minutes. There are no right or wrong answers — we are looking for honest ones. The information will help us understand your candidature better for the role.

Before we start

Please enter the mobile number you'd like us to use for all further communication. You can also come back to this form using this number.

Your Mobile Number * Enter your mobile number, with or without the country code (e.g. +919876543210)

Care Counsellor Candidate Profile

Tell us about yourself

This form takes 25–30 minutes. There are no right or wrong answers — we are looking for honest ones. The information will help us understand your candidature better for the role.

Section 1 of 7

Basic Details

Your name, contact, and location

First Name *

Last Name *

Date of Birth *DD / MM / YYYY

Mobile Number *

City you live in *

Neighbourhood / Locality*Helps us match you to families nearby

Languages you speak comfortably *Select all that apply

English

Hindi

Kannada

Tamil

Telugu

Marathi

Bengali

Punjabi

Malayalam

Other

Highest level of education / Degree earned*e.g. PhD, Graduate, Diploma — include subject if relevant

Have you ever been charged for a criminal offence? * This is asked for background verification purposes only.

Yes — I will provide context

Section 2 of 7

Your Week

Help us understand how your time is structured. We are not looking for the right kind of schedule, just an accurate picture of your life.

Q1 Walk us through a typical week in your life. * Tell us about your daily routine, who else is at home, what your fixed commitments are, and when you are generally free.

Q2 If something urgent came up with the parent you look after, how would your week need to adjust to make that possible? * We want to understand what flexibility looks like for you in practice.

Section 3 of 7

Your Experience

What you have done and what it taught you.

Q3 Have you ever cared for an elderly person – at home, or at work?*

Yes

If yes, tell us briefly about that experience.If no, you may leave this blank.

Section 4 of 7

What Draws You To This Role,

This is a very important question. Please take your time. We are looking for honest, specific answers, not polished ones.

Q4 What is it about this work that draws you to it? * Please go beyond 'I like helping people'. Tell us something specific - a moment, a feeling, a person...

Section 5 of 7

Your Home & Family

These questions help us understand your home situation, not to judge, but to make sure this role genuinely fits your life.

Q5 Tell us a little about your family, who you live with, and what they do. *

Q6 Does your family know you are applying for this role? *

Yes, and they are supportive

Yes, but they have some concerns

Not yet — I haven't told them

Q7 Who takes care of home responsibilities when you are out? *

Spouse / partner

Family member / in-laws

Paid help / housekeeper

My children are independent

I live alone

Other

Any additional context about your home situation?

Q8 Looking back at someone you have cared for or supported, at home or at work, what is one thing you wish you had done differently?

Section 6 of 7

References

We ask for one or two people who know you well, personally or professionally, and would be willing to speak briefly about you. Family members are welcome if they are your most meaningful reference.

Reference 1 *

Full name *

Mobile number *

Why have you chosen this person (optional)?

Reference 2 (optional)

Full name

Mobile number

Why have you chosen this person?

Section 7 of 7

Declaration

One final confirmation before you submit.

All information I have provided is truthful and accurate to the best of my knowledge.

I understand that Samarth Eldercare will verify the details I have shared.

I understand this role involves non-fixed hours, home visits, and occasional emergency support.

I give my consent for Samarth to contact my references and process my application data for recruitment purposes.

I have read and agree to the above declaration *

Signature (type your full name) *

Date *

Tell us about yourself

Tell us about yourself

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