Employment Missouri Personal Care Attendant Employment Questionnaire Another Day provides support services to individuals with disabilities enrolled in Missouri State Medicaid. The services are provided by a Personal Care Attendant in the home or in the community and are oriented around Activities of Daily Living, Individualized Skills Development, and Community Integration. Typical activities include: hygiene, transfer/mobility, meal preparation, exercise, education, health maintenance activities, recreational or social activities, and other skills development activities that promote independence for the individual in their home and in the community. If you are interested in providing care to an individual with a disability, please complete the questionnaire below. We will keep your information on file for 6 months and may contact you, if necessary. Please complete ALL fields below. Basic Information First Name Last Name Address City State ---KSMO Zip Code Home Phone Cell Phone Email Availability Minimum hours per week you are willing to work ---5 hours10 hours20 hours30 hours40 hours Maximum hours per week you are willing to work ---10 hours20 hours30 hours40 hours Days you are willing to work SunMonTueWedThurFriSat Times of day you are willing to work MorningsAfternoonsEveningsOvernights Maximum Distance you are willing to travel ---5 Miles10 Miles20 Miles30 Miles Education/Certificates High School Diploma/GED YesNo Do you have experience as a Caregiver? YesNo If so, how much? ---Less than 1 year1-2 yearsMore than 2 years Certificates CPRFirst AidL1MACNALPNMANDT/NCI Review & Submit How did you hear about us? ---Online AdFriend/Current EmployerFlyer/Paper Ad Please note: This is not an employment application. This is an online questionnaire that provides basic information about you and indicates your interest in a possible position, if one should become available in the future. Another Day will keep your information on file for 6 months and may contact you during this time, if a position meeting your preferences becomes available. At that time, you may be asked to complete an employment application and undergo background checks.