Empowered Services · Caregiver Interest Form

Tell us where, when, and how you want to work.

Create a short profile so Empowered Services can consider you when a customer may be looking for a caregiver with your location, availability, strengths, and support preferences.

Get started in about 1 minute
No résumé required
Statewide interest welcomed
Matching profile

Already chosen by a customer? We’ll route you to the Empowered Choice pathway instead. Looking for a listed opening? View current jobs.

Form updated October 17, 2026 · Revision 1

Step 1 of 4 · Get started Matching details come after we know how to reach you.

1. Get started 2. Availability 3. Match fit 4. Review

Step 1 · About 1 minute

Start your caregiver interest.

First, tell us how to reach you and make sure this is the right pathway.

Has a specific customer already chosen you as their caregiver? *

NoI want Empowered Services to consider possible customer matches.

YesSomeone has already chosen me as their caregiver.

Not sureI need help choosing the right pathway.

Empowered Choice — your proposed coverage / Su propuesta de apoyo

Your estimate does not confirm coverage or remove hours from matching. Both people and the Care Team must confirm the arrangements. / Esta estimación no confirma la cobertura ni reduce las horas por cubrir; ambas personas y el equipo deben confirmarla.

Which customer would you support? / ¿A qué cliente apoyaría?How much of this customer’s support could you provide? / ¿Qué parte del apoyo podría brindar?About how many hours each week could you provide for this customer? / ¿Cuántas horas por semana podría brindar a este cliente?

Check blocks only if the whole block works. Leave uncertain days blank or choose “Not sure.” The Care Team will confirm exact times. / Marque un bloque solo si puede cubrirlo completo. Si no sabe, déjelo en blanco o elija “No sé”.

When could you support this customer? / ¿Cuándo podría apoyar a este cliente?
Day / Día	6–10 am	10 am–2 pm	2–6 pm	6–10 pm	10 pm–6 am (+1)	Unavailable / No disponible	Not sure / No sé
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Start date, if known / Fecha de inicio, si la sabeTime zone / Zona horariaWould you like additional hours supporting OTHER customers? / ¿Desea horas adicionales con OTROS clientes?

The Care Team will confirm your employment and current commitments before accepting additional-hours availability. / El equipo confirmará su empleo y compromisos antes de aceptar su disponibilidad.

Empowered’s scheduling cap is 35 hours across all Empowered work. The Care Team checks this in HUB and payroll. Human connection is not scored. / El límite de programación es de 35 horas entre todos los turnos de Empowered. El equipo lo verifica en HUB y nómina. La conexión humana no se puntúa.

First name *

Last name *

How should we contact you? *

Best time to reach you Optional

Phone

Required for text or phone contact.

Required if email is your preferred contact method.

Preferred language for us to use when contacting you Optional

Choose “Another language” to tell us the specific language to use.

What happens when you continue

When you continue from Step 1, your contact request is sent to Empowered Services for follow-up. Schedule and profile details are sent only when you submit the final review. Answers are not saved as you type; refreshing starts a new form.

Looking for a current job opening instead?

Thanks — your contact details are in.

Now add the basics we use to look for a practical match.

Step 2

Where and when could you work?

Keep this broad. Details can be discussed later if a possible match develops.

Home city Optional

Home county in Oregon Optional

This is where you live. You can separately tell us which counties you would consider working in below.

Home ZIP code *

How far would you usually travel? *

Weekly calendar

Use local times where support takes place. Enter exact times if known, or choose parts of the day. These are reported preferences, not assigned shifts.

Your answer

Available or requested from

Until (leave blank if ongoing)

Select the hours you want on each day. Select an hour again to clear it. For partial hours, broad preferences or overnight ranges, use the exact-time controls below.

Exact times and day preferences

Temporary changes or unavailable dates (optional)

Weekly hours wanted or currently available for new support

Your answer

Maximum one-way travel time in minutes

Your answer

Maximum one-way travel distance in miles

Your answer

Shortest shift you would consider, in hours

Your answer

Would you consider split shifts?

Desired weekly hours *

When might you want to start? Optional

What general work schedule would you prefer? Optional

This is your preference. Specific hours and schedules can be discussed later.

Anything else about counties or travel? Optional

You can share travel preferences or limitations, or leave this blank. Up to 600 characters.

Contact arrangements for your Care Team

These details are for follow-up, separate from the hours when support is needed or offered.

Which days and times are best for us to contact you?

Use local time where you are. Add up to seven contact windows.

Day	From	To
Day 1	From 1	To 1
Day 2	From 2	To 2
Day 3	From 3	To 3
Day 4	From 4	To 4
Day 5	From 5	To 5
Day 6	From 6	To 6
Day 7	From 7	To 7

Corporate Office

Phone Number

Tell us where, when, and how you want to work.

Start your caregiver interest.

You’re in the Empowered Choice pathway.

Where and when could you work?

Exact times and day preferences

What kind of match may fit you?

Supported activities and preparation

A little more about you and practical next steps

Review and send.

Your caregiver profile was received.

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