First-Care Interview

* fields are reqiired

*Name		Date
*Email		*Phone

!! Please Answer All Questions !!

*How did you hear about First Care Of New York?

Are you currently employed?

Yes No

If no, how long have you been out of work

*What is you availability?

Can you work every weekend?

Yes No

Every other weekend?

Yes No

*Which of the 5 Boros are you willing to travel to:

Manhattan	Bronx	Brooklyn	Queens
Staten Island	Westchester County	Other

Do you drive?

Yes No

Do you have a car?

Yes No

Would you have a problem with transportation?

Yes No

Explain:

Would you work a live in case (24 Hour shifts)?

Yes No

Will you work with male patients?

Yes No

Do you speak Spanish?

Yes No

If no will you work with a Spanish speaking patient?

Yes No

What would you do in the following scenarios?

*Your patient requests that you stay longer than you are supposed to or she says she will pay you extra if you stay longer.

*Your patient becomes agitated, upset, angry etc. and asks you to "leave right now."

*You are on a long hour case and you have a family emergency.

*Your patient gives you a large sum of money to go to the store and says you can keep the change.