Sara Companion Home Care Services

SARA Location Preference Questionnaire

HHAs and nurses should have the flexibility they need. Please fill in the following form so that we can have a clear picture of the locations that work best for you.

Locations

Location, location, location is everything! Please let us know which zone you live in. Then, please indicate what zones you would be willing to work in, plus check off the towns or cities within these zones as well. You may check as many locations as you wish. A map has been supplied for easy reference.

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Name

First

Last

Position at SARA

Date

Zone C – Township of Shelter Island

Yes, I will work in Zone C
No, I won’t work in Zone C
Village of Shelter Island
Shelter Island Heights

Zone N – Queens

All areas in Zone N
No areas in Zone N
Select Areas of Zone N

If you chose Select Areas in Zone N, please tell us your preferences.

Zone O – Brooklyn

All areas in Zone O
No areas in Zone O
Select areas of Zone O

If you chose Select Areas in Zone O, please tell us your preferences.

Zone Q – Staten Island

All areas in Zone Q
No areas in Zone Q
Select areas in Zone Q

If you chose Select Areas in Zone Q, please tell us your preferences.

Zone R – Manhattan

All areas in Zone R
No areas in Zone R
Select areas in Zone R

If you chose Select Areas in Zone R, please tell us your preferences.

Zone S – Bronx

All areas in Zone S
No areas in Zone S
Select areas in Zone S

If you chose Select Areas in Zone S, please tell us your preferences.

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Work Location Preferences

SARA Location Preference Questionnaire

Locations

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