Questionnaire

Date

Name *

Email *

Phone

Address

Position Title

1. How many years’ experiences do you have as a disability support worker or PCA?

2. Please advise the qualifications you have achieved and the ones you are working towards completing.

3. Please advise any experience you have in the manual handling. (Example: hoist etc)

4. Kindly list below the medical conditions that you have worked with.

5. Do you have car and valid driving license to travel for work?

6. How far will you be willing to travel?

7. Languages You Know (Kindly write each separated with a comma.)

8. Have you worked with complex/ high needs clients?

9. What has been the most stressful situation you have ever found yourself in at work? How did you handle it?

10. Have you done Peg Feeding training?

How many days are you willing to works? Kindly mention the days that you can work and also mention the time that you would be able to work.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

13. Do you have experience working with children? Kindly provide details below.

14. Have you worked with clients with Behaviours of concerns? Kindly provide the details below

15. Please provide your hourly rate expectations and your preferred working location (West, East, North, South) as a casual support staff.

Please provide your employment references.

Reference 1(Name & Phone)

Reference 2(Name & Phone)