Application for employment

Please make sure you go through and complete all sections of the application.


Summary



Personal Details



Driving History



Availability


Day Morning Afternoon Evenings Overnights
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Education History


Name Years Attended Graduation Degree

Employment History



Employmer 1


Employmer 2


Employmer 3


Challenges



Background checks


NAR and EMR Checks

Before this agency hires an unlicensed employee whose duties would or do involve face-to-face contact with a client this agency must search the nurse aide registry (NAR) and the employee misconduct registry (EMR) to verify that a applicant is not listed with a finding concerning abuse, neglect, or exploitation or mistreatment of a client of an agency or a facility, or misappropriation of a client’s property as required by Texas Health and Safety Code §253.008. Any persons listed on the EMR are not employable.

Criminal Background Checks

A person in direct contact with a consumer of service must have a criminal history conviction check initiated before employment can be offered. This is required for unlicensed employees only. Please indicate by a check mark if you have EVER been convicted of any of the following offenses; these may interfere with you working directly with clients and may bar you from employment.

Criminal homicide (Chapter19, Penal Code) Kidnapping and false imprisonment (Chapter 20, Penal Code) Indecent exposure (Section 21.08, Penal Code)
Indecency with a child (Section 21.11, Penal Code) Improper relationship between educator and student (Section 21.12, Penal Code) Improper photography or visual recording (Section 21.15, Penal Code)
Assault, Class A misdemeanor or as a felony; (Section 22.01, Penal Code) Sexual assault (Section 22.011, Penal Code) Aggravated assault (Section 22.02, Penal Code)
Terroristic threat (Section 22.07, Penal Code) Deadly conduct (Section 22.05, Penal Code) Abandoning or endangering a child (Section 22.041, Penal Code)
Injury to a child, elderly individual, or disabled individual (Section 22.04, Penal Code) Aiding suicide (Section 22.08, Penal Code) Agreement to abduct from custody (Section 25.031, Penal Code)
Sale or purchase of a child (Section 25.08, Penal Code) Arson (Section 28.02, Penal Code) Robbery (Section 29.02, Penal Code)
Aggravated robbery (Section 29.03, Penal Code) Felony Theft (Chapter 31 Penal Code) Burglary (Section 30.02, Penal Code)
Misapplication of fiduciary property or property of a financial institution that is punishable as a Class A misdemeanor or a felony (Section 32.45, Penal Code) Securing execution of a document by deception, Class A misdemeanor or a felony (Sect32.46) Online solicitation of a minor (Section 33.021, Penal Code)
Money laundering (Section 34.02, Penal Code) Medicaid fraud (Section 35A.02, Penal Code) False identification as peace officer (Section 37.12, Penal Code)
Disorderly conduct (Section 42.01 (a) (7) (8) or (9), Penal Code) Cruelty to animals (Section 42.09, Penal Code)

Employment Agreement


Terms

I will respect the confidentiality regarding information that I receive either about Life Made Easy Home Health or client information. I understand that not sticking to the confidential policies of the company will be reason for termination of employment.

I will respect all employees and clients of Life Made Easy Home Health.

I will report accurately and in a timely fashion the time that I have worked.

I will provide accurate documentation regarding my work with clients.

I will be responsible for all equipment, given to me by the Company that I will use as an employee of Life Made Easy Home Health. I will return all equipment at the request of the Company, or when the equipment is no longer required in the service to the Company.

I understand the importance of the communication between the client(s)and the administrative office.I will always refer to the administrative office any client concerns, schedule changes, and any other information relevant to the care of the client.I hereby declare that the information provided by me in this application for employment is true, correct, and complete.In making this application for employment, I understand and agree that any misrepresentations made by me in this application will be sufficient cause to revoke any offer of employment or grounds for immediate discharge. I authorize that my employers and business associates may verify all information, schools I have attended, and any other person whom I have listed on your application.These people may furnish to Life Made Easy Home Health any information concerning my character, ability, general reputation, and / or history of my employment.I release each person of any liabilities which may be incurred by furnishing such information.

If I am hired, I agree to conform to the rules and regulations of Life Made Easy Home Health and that my employment and compensation can be terminated with or without cause, and with or without notice, at anytime, at the option of either Life Made Easy Home Health or myself.

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