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* 1. Personal Information:

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* 2. How many hours per week are you able to work?

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* 3. How did you hear about this position?

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* 4. Have you ever taken care of someone in a home setting?

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* 5. Which of the following types of clients do you have experience caring for?

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* 6. Which of the following do you have experience with?

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* 7. Are you familiar with clocking in and out using "LASERS" website from your phone?

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* 8. How soon are you available to start?

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* 9. What days of the week are you available

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* 10. If you are available during the Days, what is the earliest and latest you can start and end your shifts?

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* 11. If you are available Overnight, what is the earliest and latest you can start and end your shifts?

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* 12. Which of the following Parishes are you willing to work in?

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* 13. Do you have any of the following?

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