Pre-Application Questionnaire Name: * Required First Last Address: * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone: * RequiredEmail: * Required What is your current status? RN C.N.A. Companion LPN PCA Homemaker Other Current Status: Other * RequiredHave you had any job-related training? * RequiredYesNoPlease describe your job-related training: * RequiredAre you a licensed driver with a clean driving record? * RequiredYesNoCan you plan, prepare, and serve meals to clients? * RequiredYesNoHow many years of caregiving experience do you have? * RequiredNone1-2 Years3-5 Years6-10 Years10+ YearsI am interested in working in: In-home Caregiver Nursing Homes Facilities Private Homes Other I am interested in working at: Other * RequiredAre you able to work in the Santa Barbara area? * RequiredYesNoWhat is your availability? * Required Nights Days Weekends Holidays Have you ever been employed with us before? * RequiredYesNoWhat is your current employment status? * RequiredEmployedUnemployedSelf-EmployedHave you ever been convicted of a felony? * RequiredYesNo(Conviction does not necessarily disqualify an applicant for employment.) What is your available start date? - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY How did you hear about us?I understand that Senior Planning Services is a temporary/part time employer. * Required I understand In compliance with federal and state law, we consider applicants without regard to race color, religion, sex, national origin, age, marital status, or the presence of a mental or physical disability, or other legally protected status.