Full Name
Phone
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Email
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In the past 3 years, how many different jobs have you held?
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a) 1-2 Jobs
b) 2-4 Jobs
c) 5-6 Jobs
d) More than 6 Jobs
What was your primary reason for leaving your last job?
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a) Career advancement
b) Company closure - layoff
c) Schedule conflicts
d) I Didn’t like the work or boss
E) Wanted easier work
How would you describe your attendance record at your last job?
a) Excellent rarely missed days
b) Good occasionally absence for a valid reasons
c) Fair missed more days than I’d liked
d) Poor attendance was an issue
How much notice did you give before leaving your last position?
a) 3+ weeks notice
b) 2 weeks notice
c) Less than 2 weeks notice
d) No notice just walked off the job
What is your longest tenure with a single employer?
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a) 3+ years
b) 1 to 3 years
c) 6 to 12 months
d) Less than 6 months
Which aspect of caregiving appeals to you most?
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a) Making a meaningful difference in people's lives
b) Stable job with great benefits
c) Working independently
d) Better pay than my last job
E) Seems like easy work
How do you view the caregiving profession?
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a) Essential Healthcare Services requiring skill and compassion
b) Important but undervalued work
c) Decent job while looking for something better
d) I just need a job right now
Where do you see yourself in 2 years?
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a) Advanced caregiver with additional certifications
b) Experience caregiver with this agency
c) Not sure depends on the opportunity
d) Hopeful in a different career
What does professional caregiving mean to you?
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a) A calling that requires dedication empathy and continuous learning
b) a respectful career helping valuable people
c) a job that pays the bills
d) something to do until better options come along
How important is client satisfaction to you?
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a) Extremely important it's my top priority
b) very important I want clients to be happy
c) somewhat important I do my job well
d) Not my main concern I just do what I'm told
Caregiving duties include helping with toileting, bathing, and cleaning up bodily fluids. Your response:
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a) I understand and accept this as a part of Professional Care
b) I can handle most tasks but some are difficult
c) I'll prefer to avoid the Messier tasks
d) I don't realize this was part of the job
The job requires frequent lifting, bending, and being on your feet for hours. Are you physically capable?
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a) Yes I'm physically fit and ready for these demands
b) yes with proper body mechanics I can manage
c) mostly but I have some physical limitations
d) no I have significant physical limitations
How do you handle emotional situations, like a client becoming upset or confused?
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a) I remain calm patient and use de-escalation techniques
b) I stay calm and try to comfort them
c) it's challenging but I manage
d) I tend to get frustrated or stressed
You may witness client health decline or end-of-life situations. Can you handle this emotionally?
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a) Yes I understand this is part of caregiving and I can provide compassionate support
b) it would be difficult but I'm prepared
c) I'm not sure how I'll handle it
d) I don't think I could handle that
Your ideal work schedule would be:
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a) Whatever schedule best serves the client's needs
b) flexible but with some consistency
c) prefer regular hours but some flexibility okay
d) strictly weekdays no holidays or weekends
Are you available to work weekends?
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a) Yes any day of the week works for me
b) yes but I prefer to have one weekend day off
c) occasionally but not regularly
d) no weekends don't work for me
A client needs coverage on short notice (24-48 hours). Your response:
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a) I'll do my best to accommodate if possible
b) if my schedule allows I'll help out
c) probably not I need more advance notice
d) no I can't change my schedule on short notice
Can you commit to a consistent schedule for at least 6 months?
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a) Yes I'm looking for long-term stability
b) yes barring any major life changes
c) maybe depends on circumstances
d) no I need flexibility to leave if needed
A client asks the same question for the 5th time in an hour. You:
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a) Patiently answer the same with kindness as the first time
b) Answer but generally explain you told them already
c) redirect their attention to something else
d) tell them they're being repetitive
How would you communicate with a client who has difficulty hearing or speaking?
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a) Use Clear speech visual aids patient and alternative communication methods
b) speak louder and slower
c) try my best but it would be challenging
d) I'm not sure how to handle that
A family member disagrees with how you're caring for their loved one. How do you respond?
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a) Listen respectfully explain my Approach and involve my supervisor if needed
b) listen and try to accommodate their concerns
c) defend my method and continue as I was
d) get defensive I know what I'm doing
A client offers you money to do tasks outside your job duties. You:
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a) Politely Decline and explain agencies policies
b) ask your supervisor before accepting
c) except if it’s yeah I heard not harmful
d) Take the money extra income is good
A client wants to include you in their will. Your response:
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a) Politely Decline and report to supervisor immediately
b) feel uncomfortable and tell someone
c) feel flattered but not sure what to do
d) except they want to do something nice
How do you maintain professional boundaries while being friendly?
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a) I'm warm and caring but maintain clear professional limits
b) I'm friendly but keep things professional
c) I sometimes struggle with where to draw the line
d) I don't see any boundaries matter if we get along
You notice a client has expensive jewelry left out. You:
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a) Continue work normally it's not my concern
b) mention it to the client for security
c) move it somewhere safer without asking
d)note its location in case something goes missing
What do you expect your starting hourly wage to be?
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a) Market rate based on my experience is 15 to $18 an hour
b) slightly above Market 18 to $20 an hour
c) well above Market $22 an hour
d) whatever you pay is fine
What do you think is the most challenging aspect of caregiving?
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a) Balance emotional involvement with professional boundaries
b) dealing with difficult Behavior or decline
c) the physical demands of the job
d) I don't expect it to be that challenging
You accidentally break a client's item. What do you do?
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a) Immediately inform the client and the supervisor offered to replace it
b) tell the client and apologize
c) leave a note explaining what happened
d) don't mention it accidents happen