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Instructions

It’s important to be completely honest and true to yourself to get the best report for you.
Go through the questions quickly and instinctively; don’t overthink your answers.
There are 156 items with 5 answer choices each.
Read each statement and rate it from 1 to 5 with 1 being “Very inaccurate” to 5 being “Very accurate”.
Try to minimize use of answer 3 “Neither inaccurate nor accurate”.

Notice

Alert

Your Choice Home Health DSP PCM

Your Choice Home Health Care welcomes you to apply for one or more open positions. Join our team of professional care givers supporting our seniors, veterans and disabled 18 years of age and older.

Information

Applicant Information First Name *

Middle / Initial

Last Name *

Street Address *

Apt

City *

State *

Zip Code *

Email * Note: You will receive an email with your confirmation number after complet ing the survey.
can't be blank
Phone *

Cell Phone

Position Applied For: Direct Support Professional

Additional Applicant Information:
Do you have a valid driver's license? *
Yes No

What is your educational level? *

Are you 18 years of age or older? (Yes / No) *

Have you ever been convicted of a felony or a misdemeanor? (Yes / No) If yes, what was the date and outcome? *

Who is your current or last employer company name? *

Optional Research Demographic Data

The following questions are optional. We seek this data for research purposes only and any individual information provided here is available only to researchers and is not available to Your Choice Home Health Care, LLC's employees.

Gender: Male Female

Ethnicity: African American
American Indian
Asian
Caucasian
Hispanic
Indian
Other

Age/Experience: Age

Years of Experience as DSP