Grandma's Place Pre-employment Survey Question Title * 1. Please provide the following: Name: * Position Applied For: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * Question Title * 2. What is the highest level of school you have completed or the highest degree you have received? Less than high school degree High school degree or equivalent (e.g., GED) Some college but no degree Associate degree Bachelor degree Graduate degree Question Title * 3. Do you have a working and reliable vehicle, valid drivers license, proof of insurance, good driving record and willingness to transport clients in your personal vehicle if requested ? Yes No Other Other (please specify) Question Title * 4. If offered a position, what hours would you be AVAILABLE to be scheduled to work on the days listed below. Keep in mind, the greater availability to work, the more flexibility a manager has to schedule employees with clients. (Example: Sundays 8am to 10pm) Sundays Modays Tuesdays Wednesdays Thursdays Fridays Saturdays Question Title * 5. Describe your previous experience with medication administration. Question Title * 6. Explain how you have documented on clients at previous employers. Question Title * 7. Describe a SPECIFIC emergency or crisis situation that you responded to. What happened; and how did you respond? Question Title * 8. What are some of the challenges or frustrations at your current job or at previous jobs? Question Title * 9. What have you enjoyed most about your current or previous job? Question Title * 10. What did you find most intriguing about the position you are applying for? Question Title * 11. Why do you feel that Grandma's Place will be a good fit for you, and for your professional goals? Done