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Caregiver Availability and Preferences Profile

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Sara Companion HomeCare Services – Caregiver Profile

Today's Date *

Cell Phone Carrier *

Last Name *

First Name *

SKILL HomeCare First

Languages Spoken *

SKILL SET (Please Check all that Apply below)

Level 1 Skills *

Companionship
Cooking/Meal Preparation
Light Housekeeping
Outdoor Activities with Client
Transportation (car)
Doctor appointments
Errands/Shopping
Light Exercise
Monitor/Wandering
Medication Reminders

Level 2 Skills *

Feed
Bath/Shower/Sponge Bath
Dress/Groom
Ambulation
Cane/Walker/Wheelchair/Scooter
Toileting
Gait
Fall Risk

Level 3 Skills *

Feeding Tube
Transfers
Hoyer
Incontinent Care
Catheter Care
Colostomy Care
Dementia/Alzheimer
Hospice
Bedbound

TYPES OF CASES / DAYS/ SHIFTS

Availability: Please be specific as to which types of cases you will accept. *

Live-In Cases
Hourly Cases

Days Available for AM Shifts *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Days Available for PM Shifts *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Special Requests (If none please just write no) *

Allergies (If none please just write no) *

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Policies & Procedures
Caregiver Levels
Your Feedback and Questions

Get in Touch Contact Information

Visit our offices at: 201 East Merrick Road, Valley Stream, NY 11580 111 Smithtown Bypass, Suite 121, Hauppauge, NY 11788 133-33 Brookville Blvd., Suite 229B, Rosedale, NY 11422

Please call the offices before coming so we can make sure that someone is in to greet you.

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Give Us a Call 516-837-3388 631-627-5589 718-527-3200
201 East Merrick Road Valley Stream, New York 11580
Email HR Compliance at:
siahn@saracompanions.com

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Caregiver Availability and Preferences Profile

Sara Companion HomeCare Services – Caregiver Profile

SKILL SET (Please Check all that Apply below)

TYPES OF CASES / DAYS/ SHIFTS

Email HR Compliance at: