Caregiver PreScreening Questionnaire
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How many years of experience do you have as a caregiver?
*
Do you have a CURRENT Tuberculosis (TB) shot record?
*
Yes
No
Are you CURRENTLY certified in First Aid & CPR?
*
Yes
No
Do you have your own transportation to reliably commute to our client’s homes?
*
Yes
No
What is the farthest distance you can travel from home?
*
What is your availability for work hours?
*
What is your required time for assignment notification (for example 2 hours or 24 hours)?
*
Why are you interested in working as a caregiver?
*
Staring pay is $15/hr, will you be willing to accept that?
*
You understand this is a PRN/Part-Time Position (this is not a full-time position)? Which means you will not have 40hr/week assignments.
Yes
No
Do you have any questions for us?
*
If selected, will you be able to submit all required documentation and credentials within 24 hours of receiving the conditional offer?
*
Yes
No
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