Caller Application – We Call Your Mom.com

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Personal Information

Full Name *

Preferred Name (if different)

Phone *

Email *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Which generation best describes you? (We ask this just for fun—it helps us celebrate our diverse team!) *

The Silent Generation (born 1928–1945)
Baby Boomer (born 1946–1964)
Generation X (born 1965–1980)
Millennial (born 1981–1996)
Generation Z (born 1997–2012)
Prefer not to say / Other:

Single Line Text

Are you currently employed? *

Yes
No
Retired

Previous Work History

Please list up to your last three positions, starting with the most recent.

Position #1

Employer: *

Position/Title: *

Dates of Employment: *

Primary Duties/Responsibilities: *

Reason for Leaving: *

Position #2

Employer:

Position/Title:

Dates of Employment:

Primary Duties/Responsibilities:

Reason for Leaving:

Position #3

Employer:

Position/Title:

Dates of Employment:

Primary Duties/Responsibilities:

Reason for Leaving:

References

Professional References

Name *

Relationship/Title *

Phone *

Name *

Relationship/Title *

Phone *

Personal References
- If employed: Please provide 2 personal references.
- If retired: Please provide 3 personal references.

1. Name *

Relationship *

Phone

2. Name *

Relationship *

Phone

3. Name (If retired)

Relationship

Phone

Personal Insight Questions

1. Why are you interested in becoming a Caller for We Call Your Mom? *

2. Why do you believe you would be a good Caller? *

Relationship/Title personally? Mailing

3. What specific strengths do you bring to this position—especially when speaking to people who may be isolated due to age, disability, retirement, or caregiving responsibilities? *

4. Describe a time you made a meaningful connection with someone who needed encouragement or companionship. What did you learn from that experience? *

5. Our callers bring warmth and genuine care to every conversation. How would you approach someone who is shy, quiet, or hesitant to talk? *

6. What does “showing someone they matter” mean to you personally? *

7. After reviewing our website (www.wecallyourmom.com), what questions do you have for us about this position or our mission? *

Availability

Which days and times are you available to make calls? *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Preferred Time(s): *

How many calls per week would you like to make? *

Are you comfortable using phone apps or logging calls digitally (for time tracking and reports)? *

Yes
No
Willing to learn

Consent & Signature

By signing below, I affirm that the information provided is true to the best of my knowledge. I understand that We Call Your Mom is a connection-based service, not a medical or mental health provider, and that all calls are focused on conversation and companionship.

Name *

First

Last

Date *

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1) Your Information (Person Requesting the Service)

Name *

First

Last

Phone *

Email *

Your relationship to the client: *

Preferred contact method: *

Phone
Email
Text

2) Client Information (Person We Will Call)

Client’s name: *

First

Last

Preferred name/pronouns (optional):

Client’s phone number: *

to Layout

Client’s address (Optional: On file in case of an emergency.)

Address Line 1

Address Line 2

City

State

Zip Code

Time zone: *

Times to call: *

Days to call: *

Mon
Tue
Wed
Thur
Fri
Sat
Sun

Call frequency: *

Daily
Weekly
Other

Specify your choice

Primary language: *

Hearing/speech considerations:

Short description of this person’s current life: *

(What you want us to know. Please do not give us personal information they would not want shared.)

3) Call Preferences (Optional but Helpful)

Topics they enjoy:

Do-not-discuss topics:

Any cognitive/medical context relevant to conversation (non-diagnostic):

Is the client aware of and consenting to these calls? *

Yes
No
Unsure

4) Emergency Contacts (Used only if we have a concern during or after a call)

Primary emergency contact

Name *

Relationship *

Phone *

Email *

Secondary emergency contact

Name

Relationship

Phone

Address authorized for wellness/safety check:

Use client address above
Different (specify):

Address

Address Line 1

Address Line 2

City

State

Zip Code

NOTE: This information will only be used if we cannot reach either contact during a concern.

5) Consent & Acknowledgments

Checkboxes *

I affirm I am the client or have the client’s permission/authority to arrange these calls.
I understand We Call Your Mom provides social connection calls and is not a medical, counseling, or emergency service.

Emergency protocol statement (please read)

In the event of an emergency involving the client while the caller is on the phone, and we cannot reach the primary or secondary contact, the caller will call the police and request a sound check to be conducted, if the address is shared.

Signature / Printed Name *

Date

Client Signature (if not the same as requester)

Date

The information provided here is used solely to deliver the service and respond appropriately to concerns during a call.

We Call Your Mom - Callers Application

Personal Information

Previous Work History

Position #1

Position #2

Position #3

References

Personal Insight Questions

Availability

Consent & Signature

1) Your Information (Person Requesting the Service)

2) Client Information (Person We Will Call)

3) Call Preferences (Optional but Helpful)

4) Emergency Contacts (Used only if we have a concern during or after a call)

Primary emergency contact

Secondary emergency contact

5) Consent & Acknowledgments

Emergency protocol statement (please read)