SEIU Local 503 Homecare Respite Survey
We are creating a list of homecare and personal support workers who are available for extra hours to help cover for providers who can't work because they are sick or don't feel safe caring and/or supporting their consumer. If you make yourself available on this list, you could be contacted by people you don't know wondering if you can help cover a shift or a consumer.
* Required
Name
*
Your answer
What type of worker are you?
*
Homecare
Personal Support Worker
PC-20
County
*
Choose
Benton
Clackamas
Clatsop
Columbia
Coos
Crook
Curry
Deschutes
Douglas
Gilliam
Grant
Harney
Hood River
Jackson
Jefferson
Josephine
Klamath
Lake
Lane
Lincoln
Linn
Malheur
Marion
Morrow
Multnomah
Polk
Sherman
Tillamook
Umatilla
Union
Wallowa
Wasco
Washington
Wheeler
Yamhill
City
*
Your answer
Email
Your answer
Phone
*
Your answer
Can this phone receive text messages?
*
Yes
No
Days available
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Required
What times of day are you available?
*
Mornings
Afternoons
Evenings
Overnight
Other:
Required
Check here to confirm you give permission to share your contact information with other providers seeking respite care
*
Yes
Required
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