RESPITE WORKERS Please send any supporting documentation to respite@ilrcc.ab.ca Please tell us about yourself:Name(Required) First Last Email(Required) Phone(Required)1. What are some of your personal interests, favorite leisure/recreation activities?(Required)2. Describe your strengths and areas you are working to improve?(Required)3. Do you like/have any animals?(Required)4. What certificates, courses, and training do you have? (Proof Required)(Required) Respite workers training course or equivelent CPR/First Aid training Non-violent crisis intervention (CPI) Med Assist or similar medication certification APRP FOIP/PIPA Other 5. What location/s do you want to work in?(Required) Calgary SW Calgary SE Calgary NW Calgary NE Rural, outside Calgary Area Other Certificates/Courses/Training6. Do you have available accommodations to offer respite care in your home?(Required)7. Do you smoke?(Required) Cigarettes Weed Vape Other Smoking - Other8. What age/s do you feel comfortable working with(Required)9. Do you have a criminal record check with vulnerable sector verification completed within the last 6 months?(Required) Yes No Other 10. Could you provide an updated resume and 3 references we could contact?(Required) Yes No If yes, please copy/paste resume and list references below11. If you are providing care in your home, are you following the Canada Food Guide while preparing and providing snacks/meals?(Required) Yes No 12. What disabilities do you have experience with?(Required) ADHD Autism Spectrum Disorder Blind Cerebral Palsy Deaf Deafblind Down Syndrome Dyscalculia Dysgraphia Dyslexia Epilepsy Hard of Hearing Intellectual Disability Invisible Disability Learning disabilities Mental Disorder Multiple Disabilities Multiple Sclerosis Muscular Dystrophy Neurological Disorder Physical Disability Spinal Cord Injury Traumatic Brain Injury Vision impairment Other Past experiences 1. Why are you interested in providing respite care services?(Required)2. Have you ever had a situation when the client was upset when the caregiver left, and how did you handle it?(Required)3. What would you do if the client did not respond to your request?(Required)4. If the client must be taken to the hospital for an emergency what steps would you take?(Required)5. Describe a difficult issue you have experienced in the past with an individual you were supporting, how did you handle it?(Required)6. Would you be willing to take the client to different community activities? Either with your own vehicle or using public transport/Access if available?(Required)Job Expectations 1. What are your expectations around the various duties and responsibilities of a respite worker?(Required)2. What types of services do you provide? (check all that apply)(Required) Personal Care Medication Routines Participation in community (ie.community based groups, recreation or leisure activities) Light Housekeeping Duties Companion care Other (Please specify below) Other services provided3. Are you willing to take the client into the community to participate in various leisure and recreation activities?(Required) Yes No 4. Would you be willing to sign a Respite Agreement outlining your role, and responsibilities, as well as a confidentiality agreement form?(Required) Yes No Work Availability and transportation:1. What types of hours are you available and willing to provide support for? (check all that apply)(Required) During the day Evenings Overnight Weekends Holidays 2. Are there specific times you are unable to work?(Required)3. How much advance notice do you require before a shift?(Required)4. Are you willing to provide support on short notice or for family emergencies?(Required)5. What is the best method to communicate with you on a regular basis? (Phone, E-mail)(Required)6. Do you have a valid class 5 driver’s licence?(Required) Yes No Do you have your own vehicle to drive with a minimum 2 million dollars liability insurance and can provide proof? Yes No
