At Sara Companion Home Care Services, we know how important it is for our caregivers and Registered Nurses to have the flexibility they need. Please fill in the following form so that we can have a clear picture of the locations and hours that work best for you.

Location

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 *

Please check the zone (i.e. county or township) where you live (you may choose more than one for multiple residences) *

• A East Hampton
• B Southampton
• C Shelter Island
• D Southold
• E Riverhead
• F Brookhaven
• G Smithtown
• H Islip
• I Huntington
• J Babylon
• K Oyster Bay
• L North Hempstead
• M Hempstead
• N Queens
• O Brooklyn
• Q Staten Island
• R Manhattan
• S Bronx

Zone A – Township of East Hampton, Villages and Towns *

• Yes, I will work in Zone A
• No, I won’t work in Zone A
• Village of East Hampton
• Village of Sag Harbor
• Amagansett
• Montauk
• Springs
• Wainscott

Zone B – Township of Southampton *

• Yes, I will work in Zone B
• No, I won’t work in Zone B
• Village of Southampton
• Village of Sag Harbor
• Village of North Haven
• Village of Quogue
• Village of Sagaponack
• Village of Westhampton Beach
• Westhampton
• Bridgehampton
• Remsenburg
• Speonk
• Water Mill
• Hampton Bays

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 D – Township of Southold *

• Yes, I will work in Zone D
• No, I won’t work in Zone D
• Village of Greenport
• Cutchogue
• East Marion
• Fishers Island
• Laurel
• Mattituck
• New Suffolk
• Orient
• Peconic
• Southold

Zone E – Township of Riverhead *

• Yes, I will work in Zone E
• No, I won’t work in Zone E
• Riverhead
• Aquebogue
• Jamesport
• South Jamesport

Zone F – Township of Brookhaven *

• Yes, I will work in Zone F
• No, I won’t work in Zone F
• Village of Patchogue
• Village of Port Jefferson
• Village of Belle Terre
• Village of Bellport
• Village of Lake Grove
• Village of Old Field
• Village of Poquott
• Village of Shoreham
• Brookhaven
• Ridge
• Stony Brook
• Bellport
• Blue Point
• Calverton
• Center Moriches
• East Moriches
• North Patchogue
• East Patchogue
• Eastport
• East Setauket
• Farmingville
• Holbrook
• Holtsville
• Manorville
• Mastic
• Mastic Beach
• Medford
• Middle Island
• Miller Place
• Moriches
• Mount Sinai
• Port Jefferson Station
• Rocky Point
• Ronkonkoma
• Selden
• Shirley
• Sound Beach
• Upton
• Wading River
• Yaphank

Zone G – Township of Smithtown *

• Yes, I will work in Zone G
• No, I won’t work in Zone G
• Village of Smithtown
• Village of Head of the Harbor
• Village of the Branch
• Village of Nissequogue
• Hauppauge
• Kings Park
• Nesconset
• Saint James
• Fort Salonga
• Hauppauge

Zone H – Township of Islip *

• Yes, I will work in Zone H
• No, I won’t work in Zone H
• Village of Brightwaters
• Village of Islandia
• Village of Ocean Beach
• Village of Saltaire
• Islip
• West Islip
• Bay Shore
• Bayport
• Blue Point
• Brentwood
• Central Islip
• Connetquot
• East Islip
• Fire Island
• Sachem
• Sayville
• Oakdale
• Great River
• Hauppauge

Zone I – Township of Huntington *

• Yes, I will work in Zone I
• No, I won’t work in Zone I
• Village of Northport
• Village of Asharoken
• Village of Lloyd Harbor
• Village of Huntington Bay
• Huntington
• Cold Spring Harbor
• Elwood
• Dix Hills
• Centerport
• Greenlawn
• Huntington Station
• South Huntington
• Melville
• East Northport
• Halesite
• Dix Hills
• Commack

Zone J – Township of Babylon *

• Yes, I will work in Zone J
• No, I won’t work in Zone J
• Village of Babylon
• Village of Amityville
• Village of Lindenhurst
• Copiague
• Deer Park
• East Farmingdale
• North Amityville
• North Babylon
• North Lindenhurst
• West Babylon
• Wheatley Heights
• Wyandanch

Zone K – Township of Oyster Bay *

• Yes, I will work in Zone K
• No, I won’t work in Zone K
• Oyster Bay
• Bellerose Terrace
• Bayville
• Brookville
• East Norwich
• Farmingdale
• Glen Head
• Glenwood Landing
• Plainview
• HIcksville
• Jericho
• Locust Valley
• Massapequa
• Massapequa Park
• Mill Neck
• Old Bethpage
• Sea Cliff
• Syosset
• Greenvale
• Woodbury

Zone L – Township of North Hempstead *

• Yes, I will work in Zone L
• No, I won’t work in Zone L
• Albertson
• Carle Place
• Floral Park
• Great Neck
• Kings Point
• Manhasset
• Mineola
• New Hyde Park
• Old Westbury
• Port Washington
• Roslyn
• Roslyn Heights
• Sands Point
• Westbury
• North New Hyde Park
• Williston Park

Zone M – Township of Hempstead *

• Yes, I will work in Zone M
• No, I won’t work in Zone M
• Village of Garden City
• Village of Valley Stream
• Baldwin
• Atlantic Beach
• Bellerose Terrace
• Bellmore
• Bethpage
• Cedarhurst
• East Meadow
• East Rockaway
• Elmont
• Franklin Square
• Freeport
• Hempstead
• Hewlett
• Inwood
• Island Park
• Lawrence
• Levittown
• Lynbrook
• Malverne
• Merrick
• North Lynbrook
• North Valley Stream
• North Woodmere
• Oceanside
• Point Lookout
• Rockville Centre
• Roosevelt
• Seaford
• South Hempstead
• Uniondale
• Wantagh
• West Hempstead
• Woodmere
• Long Beach

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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