Employment Opportunities

To apply for employment please fill out the forms below in full.

    Application For Employment











    EDUCATION







    TRAINING

    PREVIOUS EMPLOYERS














      Employee Skills Checklist



      Directions: Please carefully assess your strengths and select the appropriate experience level for each skill. Please put appropriate skill level next to all skills mentioned below.

      1 = Expert 2 = Experienced 3 = Familiar 4 = No Experience

      Personal Care ADL

      Bed Bath
      Sponge Bath
      Tub Bath
      Shower
      Nail & Skin Care
      Hair Care
      Oral Hygiene
      Brush
      Denture Care
      Shave/Razor
      Assist w/ dressing

      Meal Preparation

      Assist w/ Feeding
      Diabetic Diet
      Low Sodium Diet
      Special Diet Instructions

      Client Transportation

      Assist in/out of wheelchair
      Use of manual wheelchair
      Use of electric wheelchair

      Transfers

      Assisting from chair to stand
      Stand to a chair
      Assisting in/out shower

      Elimination

      Use of bed pan
      Use of bedside commode

      Housekeeping Duties

      Washing clothes
      Folding clothes
      Dishes
      Mop Floors
      Vacuum
      Grocery Shopping/Errands
      Dusting


        Health Attestation Form




        Date of First Case: (first day worked)

        Post-Offer Physical
        Post-Offer Physical

        Rubella Screening
        Rubella Screening

        Rubeola Screening
        Rubeola Screening

        Employee Birth Year:

        Initial TB Screening
        Initial TB Screening

        IGRA blood test

        2-step Mantoux Screening

        Annual Mantoux
        after initial 2-step (Month due: )

        Date of chest x-ray
        TB questionnaire
        Date of Chest Xray

        Date of TB questionarire

        Annual TB Screening
        Date of Annual TB Screening

        Hepatitis B Vaccine
        Date accepted/declined

        Influenza Vaccine (if warranted)

        Periodic Physicals (if required by agency)

        Designated Reviewer

        Name:
        Title:

        ---

        Name:
        Title:

        ---

        Name:
        Title:


        Alternate Assessment - TB Screening Questionnaire

        This form is completed annually for those employees who have documentation of a negative chest x-ray following a positive Mantoux screening test, and whose medical evaluation and chest x-ray indicate that no further Mantoux screening is required.

        Do you experience any of the following:

        Bad cough that lasts longer than 2 weeks

        Coughing up sputum (phlegm)

        Coughing up blood

        Loss of appetite

        Weakness/fatigue/tiredness

        Night sweats

        Unexplained weight loss

        Fever

        Chills

        Chest pain

        Have you recently spent time with someone who has infections tuberculosis?

        Any other complaints?

        Nurse Reviewer Recommendation