Pre-Screening Application Contact Information Full Name Email Address Phone Number Full Address Town/City Position Specific Information Starting Pay is $10.25/hr (non-negotiable). IF unacceptable please STOP here. Do you have any Personal Care experience? Do you have any experience with Personal Care equipment? Are you equally comfortable with male and female consumers? Yes No Are you comfortable in a smoking environment? Yes No Are you comfortable with pets, such as dogs and cats? Yes No Do you have any lifting restrictions? Yes No Will you be able to pass a criminal and BEAS background check? Yes No If a position requires driving, do you have 100/300 Liability on Auto Insurance? Yes No How many hours are you looking for? Which days of the week are you able to work? Check all that apply. Sunday Monday Tuesday Wednesday Thursday Friday Saturday What hours would you be able to work? Check all that apply. Morning Afternoon Evening Please list specific towns you are willing to drive to. How did you learn about GSIL? FacebookCraigslistFriend/FamilyGSIL WebsiteOther Click here to learn more about our Home Care Services.