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Apply for a Caring Career at Alarys Home Healthcare
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This section is only to be completed by those applying for positions requiring regular use of personal vehicles on Company business (must have valid license).
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List any traffic violations that you have received in the past 36 months (other than parking violations).
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Please list three professional references who can attest to your skills as they relate to the position for which you are applying.
Please list three professional references who can attest to your skills as they relate to the position for which you are applying.
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TERMS OF ACCEPTANCE AND SIGNATURE
I, the applicant for this form, warrant the truthfulness of the information provided in this application.
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Caregiver Profile
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Do you have an insured vehicle or reliable transportation?
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Are you available after hours?
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Are you a smoker?
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Can you work with clients who smoke?
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Can you work with clients with pets?
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Are you able to lift?
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Do you have experience with a Hoyer lift or gait belt for transfers?
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TERMS OF ACCEPTANCE AND SIGNATURE
I have reviewed the job description for the position which I am applying and certify that I meet the minimum requirements. Additionally, I have reviewed the examples of immediate disqualifiers for consideration of employment and don’t expect those disqualifiers or similar to affect my ability to be considered for employment.
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I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
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Drug Free Workplace Consent to Test and Policy Acknowledgement Form
I have received, read and understand the Alarys Home Health Drug Free Workplace Policy. I acknowledge that I may be required to complete a pre-employment drug test. I consent to the drug test and understand that I am expected to comply with the testing requirements to be considered for employment. Furthermore, I understand that I may be subject to other types of drug and/or alcohol testing as outlined in this policy.
By my signature below, I acknowledge, understand, accept and agree to comply with the of the Drug Free Workplace policy.
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CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK IN COMPLIANCE WITH THE FCRA (FAIR CREDIT REPORTING ACT)
This authorization and consent for release of personal information acknowledges that Alarys Home Care (Hereafter referred to as “Company”) and/or its agent, C4 Operations LLC, may now, or at any time I am enrolled in, assigned to, volunteer with or am employed by this Company, conduct investigations whether the records are of a public, private or confidential nature. These investigations might include, but are not limited to: searches of educational institutions attended; state driving records; financial or credit institutions; employment, including work history, efficiency ratings, complaints and grievances filed by or against me; records and recollections of attorney-at-law or other counsel, whether representing me or any other person (in either a civil or criminal case in which I have been involved); records from the U.S. Veteran’ Administration; criminal history information on file in local, state or federal agencies; and motor vehicle records, and following an employment offer, workers’ compensation reports from either the Department of Labor, National Personnel Records or the Industrial Commission or similar agencies under the provisions of the Fair Credit Reporting Act 15, USC section 1681 et seq. I also authorize the National Personnel Records Center, or other custodian of my military service record, to release to C4 Operations LLC, the following information and/or copies of documents from my military service record: DD214, service record, and any disciplinary records.
I understand that these searches can be used to determine eligibility under the Company policies. Therefore, I authorize the consent for full release of records (either orally or in writing) to the authorized representatives of the Company. I understand that according to the Federal Fair Credit Reporting Act, I am entitled to know whether employment was denied based upon the information obtained and received, upon written request, a disclosure of the background report. I also understand that I may request a copy of the report from C4 Operations LLC, by sending a written request to 1201 Edgewood Rd SW, Cedar Rapids IA 52404-2344, calling (888) 519-6283 or submitting an email request though our website www.C4Operations.com. After reading this document, I fully understand its contents and authorize the background verification.
Are you applying for employment in California, Minnesota or Oklahoma?
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If so, do you want a copy of any Consumer Report prepared concerning you?
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Basic information
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Motor Vehicle Records Check
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Please provide a complete address history beginning with your current physical address. No PO Boxes.
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TERMS OF ACCEPTANCE AND SIGNATURE
I understand that California law requires Company to give me a copy of any report requested within three (3) days of the date the information was obtained and that failure to do so will expose Company to liability (Section 1786.16).
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I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
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Hepatitis B Vaccine Declination Form
I understand that due to my occupational exposure to blood or other potential infectious materials, I may be at risk of acquiring Hepatitis B Virus (HBV) infection.
I have been provided with information about the risks and benefits of vaccination against and have been offered the opportunity to ask questions I may have.
I decline the Hepatitis B vaccination at this time, I understand that I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccination series from my primary care physician.
I decline the vaccine, I understand that I may receive the vaccine at any time by contacting my primary care physician/facility.
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I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
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Emergency Contact Form
Employee Name
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Primary Emergency Contact
Name
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Secondary Emergency Contact
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Final Information
Job Description
Position Title: Caregiver/Direct Care Worker (DCW)
Job Code: 3016
Department: Non-Medical
Reports to: Staffing Supervisor/Staffing Coordinator
FLSA Status: Non-Exempt
Position Summary
The Caregiver/Direct Care Worker (DCW) is responsible for providing non-medical homecare services to children, elderly, chronically ill, disabled, recuperating patients and other persons who wish to receive care assistance in the comfort of their homes. Services are also provided to those living in nursing homes or assisted living facilities. The primary goal of Caregivers is to help individuals remain in a familiar environment and maintain a feeling of independence.
Position Accountabilities
The following are essential accountabilities: Performs light housekeeping for the patient only including; dusting furniture, laundry and ironing, changing linens and make bed, organizing living areas, taking out garbage and care of house plants.
Promotes a safe environment for patients by providing a stable bathing environment, monitoring food expiration, serving as an escort to appointments, overseeing home deliveries and appointments and planning errands, visits and trips outside of the home.
Assists with meal planning, preparation and clean up. Grocery shopping, recipe organization, shopping list preparation and coupon clipping. Medication reminders.
Serves as a companion; discussing current and historical events, playing mind stimulating games, reading books and magazines, renting and playing movies, watching television programs and managing appointments and social calendar.
Knowledgeable of the service limitations and authorized care guidelines as provided by ALTCS Case Manager. Calls for clarification on any service/ care assistance requests not clear in the guidelines and notifies Alarys of any changes in condition or status of patient.
Responsible for taking a role in maintaining the skills and qualifications necessary to provide quality care, including attendance at in-services programs. Notifies supervisor of educational needs.
Responsible for submitting accurate time and attendance records and following proper procedures for reporting and making corrections to attendance records.
Regular attendance in conformance with the standards, which may be established from time to time, is essential to the successful performance of this position. Position is responsible for harmonious interactions with coworkers and customers, including patients, family members, physicians and the general public. Upon employment, all employees are required to fully comply with Alarys Home Health’s policies and procedures.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees tn this position.
TERMS OF ACCEPTANCE AND SIGNATURE
| understand that California law requires Company to give me a copy of any report requested within three (3) days of the date the information was obtained and that failure to do so will expose Company to liability (Section 1786.16).
Accept
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I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
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