PRE-EMPLOYMENT SCREENING

First Name *

Last Name *

Email *

Phone *

SECTION A: Shift Flexibility & Availability

Q2. A client cancels your 8-hour shift last minute. What’s your response? *

Get upset—it messes up my day

It happens—I’ll wait for another shift

I offer to fill another case that day

Q3. You’re booked 3 days in a row with different clients and shift lengths. How do you handle it? *

That’s too inconsistent—I need a regular schedule

I’ll try to manage but prefer one client

I’m flexible—it’s part of caregiving

SECTION B: Home Environment Adaptability

Q4. You’re asked to work in a home with multiple pets and family members present. *

I avoid that—it’s too chaotic

I’ll try it and see how it goes

No problem—I’ve worked in those setups

Q5. The client is bedbound, but the family expects help with light housework too. You… *

Only do what’s in my job description

Help within reason, then communicate limits

Support the home as best I can and alert the agency if it’s too much

SECTION C: Physical Stamina & Rest-Aware Commitment

Q6. How do you manage back-to-back shifts with minimal downtime? *

I try to avoid them

I take them but feel drained

I prepare in advance and stay rested

Q7. After working a full-day shift, you’re asked to work again later that same day. What do you do? *

Say no—I legally need rest.

Check my energy and schedule first

Accept it—I’m built for it

SECTION D: Reliability & Case Continuity

Q8. Which best describes your work preference? *

I want consistent hours with one client only

I prefer variety but need a stable schedule

I’m open to any shift if it means helping clients

Q9. What does being a caregiver mean to you? *

Q10. You work a short 4-hour case. The client asks you to stay 2 more hours. You… *

Decline—it wasn’t scheduled

Ask the agency first, then decide

Stay if the agency approves—it’s for the client

SECTION E: Transportation & Experience Screening

Q11. Do you currently have reliable transportation to job sites? *

No

Yes

Q12. What’s your caregiving experience? *

Less than 6 months

6–12 months in a nursing home

1+ year in an agency, hospital, or facility