Application Form - Aven Care Providers

Job Application Form

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PERSONAL INFORMATION

Name *

First

Middle

Last

Other names used before

Social Security Number *

Gender *

Date of Birth *

Marital Status

HOME ADDRESS INFORMATION

Address Line 1 *

Address Line 1

Address Line 2

City *

City

State *

State

Postal Code *

Postal Code

Country *

Country

Driver’s License # / State ID # / Int.Passport # *

Issue Date

Expiry Date

State Issued

City/State of Birth *

Country *

CONTACT INFORMATION

Cell Phone or Pager *

Home Phone

E-Mail Address *

Mailing Address (if different from above)

City

State

Zip

1) In case of an Emergency give information on who we should contact: *

Relationship to You

Phone 1 *

Phone 2

Position Applying For and Availability

Position *

Specify (If Other) *

Do you have the requisite experience in the position you are applying for as specified in the job description? *

Are you able to work (Select ALL that Apply) *

between 8 AM and 4:30 PM
between 4:30 PM and 12 AM
between 12 AM and 8 AM
Weekends
Holidays
On call

EDUCATION (include city/state/country)-begin with last school attended

1) School *

Diploma/Certificate/ Degree/License Earned *

Year: From *

Year: To *

2) School

Diploma/Certificate/ Degree/License Earned

Year: From

Year: To

EMPLOYMENT HISTORY

1) Employer *

Employment Dates: From *

Employment Dates: To *

Address *

Name of Referee

Relationship

Phone #

2) Employer

Employment Dates: From

Employment Dates: To

Address

Name of Referee

Relationship

Phone #

3) Employer

Employment Dates: From

Employment Dates: To

Address

Name of Referee

Relationship

Phone #

I give permission for you to contact my current employer for a reference. *

I agree
I disagree

PERSONAL REFERENCES

Name

Address

Phone #

Name

Address

Phone #

PROFESSIONAL LICENSE / CERTIFICATIONS

Home Care Aide (HCA)

License #

Effective Date

Expiration Date

Direct Support Professional (DSP) ONE

Effective Date

Expiration Date

Direct Support Professional (DSP) TWO

Effective Date

Expiration Date

Certified Nurse Assistant (CNA)

License #

Effective Date

Expiration Date

Certified Home Health Aide (CHHA)

License #

Effective Date

Expiration Date

Licensed Vocational Nurse

License #

Effective Date

Expiration Date

Registered Nurse (RN)

License #

Effective Date

Expiration Date

Other

License #

Effective Date

Expiration Date

CPR or BLS-C

Effective Date

Expiration Date

FIRST AID

Effective Date

Expiration Date

Auto Ins. Policy No.

Effective Date

Expiration Date

Professional Liability Ins. No.

Effective Date

Expiration Date

TRAINING

Please inform us of training (s) you have obtained, or if this section does not apply, go to the next section.

1) Name of Facility

Organizing Body

Certificate

Effective Date

Expiration Date

2) Name of facility

Organizing Body

Certificate

Effective Date

Expiration Date

Any Special Certifications obtained e.g. Chemo, Vent, etc?

Areas of expertise? e.g. i.e., computers, children?

What special qualifications do you have that would be helpful in this position (e.g., speak a foreign language, sign language, proficient with specific computer programs, IV Certified, sewing, art, drawing, socialization skills, athletic, video games, etc.?

Please read before agreeing: *

I agree

By checking this box, I verify that the information provided in this application is true and complete. I understand that falsification, including withholding of information, on this application is grounds for immediate dismissal if I am selected for a position. I further understand that if I am hired, can be terminated, with or without cause and with or without notice. I agree to have my picture taken for identification purposes and to submit to drug screening tests, upon request. I understand that all references listed above may be contacted in addition to past employers and educational institutions.
I verify that I have read the above, had an opportunity to clarify information about items I did not understand and agree with the above parameters.

EQUAL EMPLOYMENT OPPORTUNITY

APPLICANT DATA FORM

AVEN CARE PROVIDERS provides equal opportunity in employment to all employees and applicants. No person shall be discriminated against in employment based on race, color, religion, sex, age (40 and over), national origin, pregnancy, ancestry, qualified medical condition, qualified physical and mental disability, marital status, sexual orientation, veteran status, or any other status, characteristic or condition protected by applicable federal or state civil rights laws.

In keeping with this commitment, we request your assistance in supplying the information requested below, which will be used to comply with government reporting requirements. Your information is strictly confidential and no employment decision will be taken based upon this information. This form will be kept separate from the application.

Thank you for your voluntary assistance in providing us with this confidential statistical information.

Name of Applicant

Application Date

Type of Position Desired

City

Country

Zip Code

Gender

Male
Female
Others

Ethnic Origin

AFRICAN AMERICAN
ASIAN AMERICAN
PACIFIC ISLANDER
AMERICAN INDIAN
HISPANIC
WHITE
OTHER

If Other, Specify

Age Group

UNDER 18
18 – 40
40 +

Veteran Status

VETERAN
DISABLED VETERAN
VIETNAM ERA VETERAN
DISABLED VIETNAM ERA VETERAN
SPECIAL DISABLED VETERAN
SPECIAL DISABLED VIETNAM ERA VETERAN
OTHER

If Other, Specify

DO YOU HAVE ANY DISABILITY WHICH MAY LIMIT YOUR ABILITY TO PERFORM THE JOB APPLIED FOR?

IF YES, WHAT CAN BE DONE TO ACCOMMODATE YOUR LIMITATIONS?

HOW DID YOU LEARN OF THE POSITION?

JOB HOTLINE
RECRUITMENT AGENCY
COMMUNITY
NEWSPAPER/TRADE JOURNAL PUBLICATION
VISIT TO FACILITY
CONFERENCE/JOB FAIR
EMPLOYEE REFERRAL
OTHER

Name/Specify

CONFIDENTIALITY AGREEMENT

The Agency acknowledges both a legal and ethical responsibility to protect the privacy of patients, clients, consumers and employees. Consequently, the indiscriminate or unauthorized review, use or disclosure of personal information, medical or otherwise, regarding any patient, client, consumer or employee is expressly prohibited. All information concerning patients, clients, consumers and employees should be held in the strictest confidence. Information contained in the records shall be disclosed only to professional persons providing the patient, client, consumer, or employee with services or referral; qualified professionals involved in conservationist proceedings on behalf of the patient, client, consumer or resident; persons designated in writing by the patient, client, consumer, resident or by his/her parent (if he/she is a minor). Medical records and information regarding a patient’s care may be read, shared, or discussed for reasons specific to the treatment plan of the patient and must involve only those individuals delivering or assessing the care of the patient, client, consumer or resident. Conversations regarding patients, clients, consumers or residents should be discreet and never held in public. Records may be copied only according to Agency policy and to comply with laws as outlined by the State of California and HIPAA as Protected Health Information. Except when required in the regular course of business, the discussion, use, transmission or in the narration of any patient, client, consumer, resident or employee information which is obtained in the regular course of employment is strictly forbidden. Refer to section 5328 of the California Welfare and Institutions Code.

All information that is gathered, maintained, or stored by the agency becomes the agency’s property and cannot be released without proper authorization from the administration. All proprietary information and all other confidential information relating to Aven Care Providers and its affiliates must not be compromised, released, traded or disclosed.

Altering information is prohibited by the agency and by law. Correction of any identified erroneous information must be done according to agency policy.

In order to protect any individual from invasion of privacy and to protect the interest of the agency, any information gathered for patient care or operations will be gathered, maintained, and stored in such a manner as to assure confidentiality.

Dissemination of information will be handled according to government laws and agency policy. Employees/Contractors will be informed during orientation, will sign the confidentiality statement, and it will be placed in the employee’s file.

My obligation to safeguard patient confidentiality continues after my termination of employment with Aven Care Providers.

By checking the box below, I can confirm that As an employee/contractor of Aven Care Providers or its subsidiaries, I have read and understand the above as it relates to the confidentiality of records and information. I understand that for legal purposes, the Agency will take corrective action if there is any violation of this policy, therefore I will strictly adhere to the terms of this confidentiality agreement. *

I have read and understood the terms of this Confidentiality Agreement.

NON-COMPETE AGREEMENT

As an employee of Aven Care Providers, the employee acknowledges that they will be in receipt of confidential information. This information shall include but not be limited to procedures manuals, in-house policies, patient lists, patient’s medical records, financial information and billing records, certifications and applications, actual and prospective markets and patients, business plans and marketing strategies, customer lists, sales and marketing data, operating systems, income statements, asset and liability information, financial projections and any other confidential information gathered, revealed, acquired, or generated by or for Aven Care Providers. Each employee shall protect and hold in confidence the confidential information to anyone except with the express written consent of the Executive Director. The employee acknowledges and understands the competitive sensitivity of the confidential information and the potential for significant material harm that could result to Aven Care Providers in the event that confidential information is disseminated to others, in particular competitors. Therefore, the employee agrees that the appropriate remedy would be an immediate injunction against the violating employee in joining and prohibiting the use and continued dissemination of the confidential information. Further, each employee agrees that the dissemination of the confidential information would cause damages for which damages could not be readily ascertained and would constitute a breach of duty owed by the employee to Aven Care Providers. Each employee agrees to pay Aven Care Providers in any action to enforce this confidentiality agreement or cost of litigation, including attorney’s fees and other damages found by the trier of fact.

As consideration for employment and for the release of this confidential information, the employee agrees not to compete against Aven Care Providers or to utilize any of the confidential information for a period of two (2) years from the date of their employment terminated with Aven Care Providers. This Non-Compete Agreement shall be limited to Los Angeles and contiguous counties. This Non-Compete Agreement is not intended to prohibit employee from working as a nurse, therapist or other position but is intended to prohibit employee from working with a competitor of Aven Care Providers in the staffing industry and utilizing any of the confidential information of Aven Care Providers or contacting any of Aven Care Providers Clients. Employee agrees and warrants that they will not contact, engage, discuss, negotiate or contract with any Client or family member of a patient for those purpose of developing or promoting home health care services of said patient. All parties acknowledge that this confidential information is of a proprietary nature to Aven Care Providers and if the confidential information was revealed to the general public or to a competitor, the revelation would destroy or impair the expected success of Aven Care Providers.

AGENCY FEE

I agree not to solicit the Agency’s clients and attempt to manage and/or provide services at any time for these designated clients without prior written consent from the Agency. An employee who wishes to work privately for the Agency’s clients shall pay an agency fee of $5,000.00.

* ANY CONTROVERSY OR CLAIM ARISING OUT OF OR RELATING TO THIS AGREEMENT SHALL BE SUBMITTED TO ARBITRATION BEFORE ONE (1) ARBITRATOR SHERMAN OAKS, CALIFORNIA IN ACCORDANCE WITH THE COMMERCIAL ARBITRATION RULES OF THE AMERICAN ARBITRATION ASSOCIATION. JUDGEMENT UPON THE AWARD RENDERED BY THE ARBITRATOR MAY BE ENTERED BY ANY COURT HAVING JURISDICTION THEREOF. ARBITRATION SHALL BE THE EXCLUSIVE, FINAL AND BINDING METHOD OF RESOLUTION OF ANY CLAIM OR CONTROVERSY BETWEEN AVEN CARE PROVIDERS AND EMPLOYEE ARISING FROM THIS AGREEMENT.

By checking the box below, I confirm that I have read, understood, and agree to comply with this Non-Compete Agreement. *

I have read, understood, and agree to comply with this Non-Compete Agreement.

POLICY ON NON-DISCRIMINATION AND SEXUAL HARASSMENT

As a recipient of Federal financial assistance, AVEN CARE PROVIDERS will not, directly or through contractual arrangements exclude nor discriminate against employees, contractors, clients nor patients in its admissions, employment,staff privileges or its provision of services and benefits, including assignments of transfers or referrals to or from the Agency, for any reason including race, creed, color, national origin, age, gender, religious belief, marital status, pregnancy, disability, sexual orientation or perceived sexual orientation, veteran status or any other consideration made unlawful by federal, state, or local laws. AVEN CARE PROVIDERS is an equal opportunity provider and employer.

CIVIL RIGHTS

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at the Title 45 Code of Federal Regulations Parts 80, 84, 86 and 91...

Aven Care Providers does not tolerate Sexual Harassment, as it is a form of gender-based discrimination.

Definition:

Under Title VII of the Civil Rights Act of 1964, any type of discrimination based on an individual’s gender (male or female) is illegal. Sexual harassment is considered to be a form of gender discrimination. According to the Equal Employment Opportunity Commission, sexual harassment is “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when submission to the conduct enters into employment decisions and/or the conduct unreasonably interferes with an individual’s work performance or creates an intimidating, hostile, or offensive working environment.”

The Agency will not tolerate any form of sexual harassment from any of its employees, contractors or patients. The Agency encourages that any behavior which could be construed as sexual harassment be reported immediately to the supervisor and/ or Administrator. There is no need to fear retaliation. Both females and males can be sexually harassed when exposed to unwelcome sexual advances or to a pattern of verbal abuse, threatening, crude, impolite, or unprofessional conduct.

Quid pro quo sexual harassment is also against company policy.
The Agency encourages and urges an employee to come forward and discuss any sexual harassment that may have occurred with the Executive Director.
Every complaint will be taken seriously and investigated immediately. Investigations will be documented.
Any employee involved a sexual harassment complaint will have a full opportunity to give a full account of their recollection of the incident or incidents.
The incident(s) will be investigated thoroughly and appropriate action will be taken.

By checking the box below, I confirm that I have read and understood the "Policy on Non-Discrimination and Sexual Harassment" provided by AVEN CARE PROVIDERS. I acknowledge that I am aware of the terms and conditions outlined in the policy. *

I have read and understood the policy.

DRUG ABUSE POLICY

STATEMENT OF PURPOSE AND SCOPE

The purpose of Aven Care Providers’ Drug Abuse Policy is to maintain a safe and healthy workplace, and to prevent accidents resulting from the misuse of mind-altering drugs by employees.

Aven Care Providers strictly prohibits the possession, use and transfer of mind-altering drugs by employees at any time while present on Aven Care Providers premises or while engaged in Aven Care Providers business.

Aven Care Providers employees must not report for duty, nor be present on clientele property, nor be engaged in Aven Care Providers business, nor be in a motor vehicle owned, controlled, or otherwise in use for AVEN CARE PROVIDERS business, while under the influence of, or in possession of any drugs other than those prescribed by a physician.

Patients or visitors may not possess, distribute and or use alcoholic beverages or controlled substances while on the premises of the property controlled by the Agency. Based on reasonable cause, the agency may conduct searches or inspections of an employee’s personal belongings and may be asked to take a drug test. Refusal to consent may result in termination. Any employee who has knowledge of a person or persons violating this policy must report it to his/her supervisor immediately.

DEFINITION OF DRUG

For the purpose of this policy, the term "DRUG" wherever it appears in this policy statement, includes all alcoholic beverages and all illegal drugs, including illegal inhalants.

CONSEQUENCES OF VIOLATION

At the sole discretion of Aven Care Providers or any of its subsidiaries, violation of any part of this Drug Abuse policy, will result in one or more of the following corrective actions:
** For Aven Care Providers employees an oral or written warning, probation, suspension or immediate discharge. A full report of any violation and its corresponding corrective action will be documented and placed in the employee's permanent file. In determining corrective action, Aven Care Providers will consider the severity of the violation, the past record of the employee, and the circumstances under which the violation occurred.

By checking the box below, I confirm that I have read and understood the Drug Abuse Policy. I acknowledge that I am aware of the terms and conditions outlined in the policy. *

I have read and understood the Drug Abuse Policy.

ADULT/ CHILD/ DISABLED ABUSE

Please read the following and then acknowledge that you have done so by signing this form in the space provided. The statement concerns your duty under the law to report instances of dependent adult abuse, child abuse, and developmentally disabled abuse that come to your attention in your professional capacity. The Agency will be happy to provide you with more information about the reporting requirements and assist you in reporting any known abusive situation, should it be required.

California Welfare and Institutions Code Section 15632 requires Home Health Agencies to provide all dependent child/adult care custodians and health practitioners who are employees after January 1, 1986, (both continuing and new employees), with the following statement. The legal definition of care custodian includes all employees of a hospital. California Law requires that this statement be signed as a prerequisite to employment by the home health agency.

In summary: Section 15630 of the Welfare and Institutions Code requires any child care custodian, health practitioner, or employee of an adult protective services agency of a local law enforcement agency who has knowledge of or observes a dependent adult in his or her professional capacity or within the scope of his or her employment who he or she knows has been the victim of physical abuse , or who has injuries under circumstances which are consistent with abuse where the dependent adult’s statement indicate, or in the case of a person with developmental disabilities, where his or her statement or other collaborating evidence indicates that abuse had occurred, to report the known or suspected instance of physical abuse to adult protective services or a local law enforcement agency immediately or as soon as practically possible by telephone and to prepare and send a written report thereof within 36 hours of receiving the information concerning the incident.

In summary: Section 11166 of the Penal Code requires any child care custodian, medical practitioner, non-medical practitioner, or employee of a child protective agency who has knowledge of or observes a child in his or her professional capacity or within the scope of his or her employment whom he or she knows or reasonably suspects has been the victim of a child abuse e to report the known or suspected instance of child abuse to a child protective agency immediately or as soon as practically possible by telephone and to prepare and send a written report thereof within 36 hours of receiving the information concerning the incident.

By checking the box below, I confirm that I have read and understood the Dependent Adult Abuse and Child Abuse reporting requirements and will comply with them. *

I have read and understood the Dependent Adult Abuse and Child Abuse reporting requirements.

OSHA BLOODBORNE PATHOGENS STANDARDS

Bloodborne pathogens are microorganisms present in human blood that can cause disease in humans. These pathogens include Hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Occupational transmission of HIV infection is somewhat more common; the lethal nature of these diseases requires that we take reasonable measures to prevent exposure.

The plan will include the identification of employees with occupational exposures, development and implementation of engineering and work practice controls, personal protective equipment, labels and signs, Hepatitis B vaccination, and post-exposure follow-up and record-keeping.

AREAS OF IMPLEMENTATION OF THE PLAN

Written Exposure Control Plan
Initiate Information and Training
Begin Required Record Keeping
Hazards for Compliance (Including Hepatitis B Vaccination)

EXPOSURE DETERMINATION

The standard, as outlined above, identifies potential exposure hazards and describes methods of dealing with hazardous situations. The plan covers all employees who could reasonably anticipate occupational exposure by contact with blood or other potentially infectious materials as a result of performing their assigned duties. Within the Aven Care Providers system, this would include all personnel assigned to the performance of cleaning services in accounts where blood and other infectious material might be associated with the customer's normal business operations, Each supervisor of employees is responsible for evaluating the nature of the environment where and employee will be performing their duties to determine which employees will receive the training, protective equipment, vaccinations and other provisions if an occupational exposure exists due to a reasonable anticipation skin, eye, mucous membrane of parental contact with blood or other potentially infectious materials.

The following types of facilities would be considered as a few examples of those having occupational exposure:

General Medical Office
Nursing Home
Dental Office
Drug Rehabilitation Center
Mortuary or Funeral Home
Abortion or Family Planning Clinic
Health Care Provider
Institutional Infirmary
Blood Bank or Blood Treatment Center

By checking the box below, I confirm that I have read, understood, and agree to comply with the Osha Bloodborne Pathogens Standards. I acknowledge my responsibility to follow the outlined procedures, use protective equipment, and participate in required training. *

I have read, understood, and agree to comply with the Osha Bloodborne Pathogens Standards.

SUBMISSION OF DOCUMENTATION AGREEMENT

I agree that all documents (Time Sheets, Daily Communication Logs, Incident Reports, etc.) will be submitted within the following schedule, according to Agency policy:

Daily Communication Logs: By the Monday following the week of visit (WEEKLY).
Weekly Timesheet: By the Monday following the week of visit (WEEKLY).
Incident Reports: Within 24hrs of the incident.
Health Screening/TB Test/Chest X-Ray: Within 16 days of hire and every 2 years following the hire date.
Address Change: Within one week of knowing of a change of address (Please note that notification is important as this will affect payroll and tax information delivery).
Closure Bank Direct Deposit/Change of Bank Account: Within one week of closing a bank account or changing any material information on the bank account. (Please note that immediate notification is important as this will impact on your payroll and may cause you to incur fees).
Updated Driver’s License/Identification: Fax or mail upon receipt of a newly issued or renewed Driver’s License/Identification, or changes showing a new address or any other information.
Change of Name: As soon as legal documents to support a change of name are received. (Please note that immediate notification is important as this will impact on your payroll and tax information).

Failure to comply with the above schedule will result in delayed payroll, employee suspension from duty, and /or re-assignment of visits to other employees in order for deadlines to be met.

By checking the box below, I confirm that I have read, understood, and agree to comply with the Submission of Document Agreement. *

I have read, understood, and agree to comply with this Submission of Document Agreement.

POLICY & PROCEDURE ON EMPLOYEE GRIEVANCE

It is the desire of Aven Care Providers to maintain employee satisfaction at all times. In order to minimize the possibility of misunderstanding, an employee is requested to discuss any problem or grievance with the employee’s immediate supervisor as soon as possible after it arises. If the employee does not promptly receive a satisfactory response from the immediate supervisor and/or the employee wishes to appeal the matter, such as disciplinary penalties or working conditions, the employee can formalize his/her complaint by following the grievance procedure outlined below:

Step One: Complete a Grievance Report Form and submit it to your supervisor.

Step Two: Discuss the grievance with your supervisor.

Step Three: If the problem cannot be alleviated at the supervisory level, it should be discussed with the Executive Director.

The supervisor should document on the Grievance Report Form the action taken to resolve the employee’s grievance. A copy of the completed Grievance Report Form should be returned to the Executive Director.

By checking the box below, I confirm that, As an employee/contractor of Aven Care Providers or its subsidiaries, I have read and understand the above as it relates to grievances and their filing. *

I have read, understood, and agree to comply with this Employee Grievance Procedure.

HEPATITIS B VACCINE

HEPATITIS B VACCINE DECLINED (NOT WANTED)

I Decline

I HEREBY ACKNOWLEDGE that I have been informed of the availability of a screening test for Hepatitis B surface antibody to determine whether I presently am immune to Hepatitis B. That test is performed on blood, which will be drawn from me and is at no cost, to employees whose jobs involve the risk of directly contacting blood or other potentially infectious materials.

HEPATITIS B VACCINE CONSENT

I Consent

I consent to administration of the hepatitis B vaccine. I understand that the hepatitis B vaccine is available, at no cost, to employees whose jobs involve the risk of directly contacting blood or other potentially infectious materials. I have been informed of the method of administration, the risks, complications, and expected benefits of the vaccine.

I have also been informed that should it be determined that I am not immune to Hepatitis B, a vaccine is available which would decrease my chances of contracting Hepatitis B.

I understand that there are risks involved in performing the test to determine if I am immune to Hepatitis B. Those risks include, but are not necessarily limited to bleeding, injury from the needle to various structures surrounding the vein from which the blood will be drawn, including injury to nerve, paresthesia, or numbness or tingling, or formation of a blood clot which could dislodge and enter my bloodstream causing severe injury or death.

I also understand that there are risks attendant in receiving the vaccine against Hepatitis B, including but not necessarily limited to an adverse reaction to the vaccine which could cause anything from mild discomfort to severe injury or death caused by an anaphylactic or allergic reaction to the vaccine. In addition to all of the above, I realize that there are also unknown, rare, unpredictable and unanticipated complications, which can possibly occur.

I understand that if I am not tested to determine whether I am immune from Hepatitis B, and/or if I am tested, and it is determined that I should receive the vaccine, I face the risk of being exposed to Hepatitis B germ and contracting Hepatitis B. I understand that if I contract Hepatitis B, I could suffer the following: pain, discomfort in suffering from the disease itself, permanent or temporary damage to my liver or other organs including my brain and heart, serious other disability, or death. In addition, I realize that there are also unknown, rare, unpredictable and unanticipated complications, which can occur as a result of contracting Hepatitis B.

I understand that I have the right to be informed of such risks and that I have the right to refuse both testing for immunity to Hepatitis B and the vaccine for it. And, if I refuse the testing or the vaccine at any time, I recognize that I may be reassigned to a position of lower exposure to the Hepatitis B virus.

Checking the box below constitutes my acknowledgment:

That I have read, understood, and agreed to the foregoing testing procedure and vaccination.
That the testing procedure and vaccination set forth above have been adequately explained to me, and that I have received all of the information I desire concerning such procedure and vaccination.

I HEREBY ACKNOWLEDGE that I have been informed of the availability of the above-testing procedure and vaccination for Hepatitis B, and have been advised that the testing procedure and vaccination is indicated for me because of the possibility that I may be exposed to Hepatitis B in the course and scope of my employment. I have also been advised as to the potentially dangerous risk and consequences of my failure to be tested and receive the vaccination at this time. Notwithstanding this advice, I hereby request that I not be tested for Hepatitis B and that the vaccine not be administered to me, and hereby release the agency, its personnel, the individuals who have advised me concerning the testing and vaccination program, from any responsibility whatsoever for un-favorable or harmful result caused by my refusal to permit the testing and/or vaccination for Hepatitis B. *

I acknowledge and agree

EMPLOYEE HEALTH QUESTIONNAIRE

NAME

HAVE YOU EVER HAD ANY OF THE FOLLOWING:

OPERATIONS

COMMENTS OR EXPLANATION

FRACTURES

COMMENTS OR EXPLANATION

HIP INJURY

COMMENTS OR EXPLANATION

BACK INJURY

COMMENTS OR EXPLANATION

TUBERCULOSIS

COMMENTS OR EXPLANATION

EPILEPSY

COMMENTS OR EXPLANATION

JAUNDICE

COMMENTS OR EXPLANATION

RESPIRATORY DISORDERS

COMMENTS OR EXPLANATION

SINUS DISORDERS

COMMENTS OR EXPLANATION

SEIZURES

COMMENTS OR EXPLANATION

CARDIAC PROBLEMS

COMMENTS OR EXPLANATION

Ever had an Industrial Accident

Explain

Hospitalizations

Explain

Currently taking medications

Drug Allergies

Explain

Other Allergies

Explain

Have you received the Hepatitis B Vaccination Series?

Explain

Date

Any long term disabilities or limitations

Explain

By checking the box below, I confirm that I have read the above and declare that I have had no injury, illness or ailment other than as has been specifically herein noted. I understand that any falsification or misrepresentation may be sufficient grounds for termination from this Agency. *

I have read the above and I acknowledge and agree

POLICY ACKNOWLEDGEMENTS

SAFE DRIVING STANDARD

** I understand that I am NOT authorized to transport any client in my personal vehicle under any circumstance and if I transport any client in my personal vehicle, Aven Care Providers will not be liable for any damages or injuries incurred.

The Agency’s insurance carriers require all staff who drive automobile as an essential part of their daily duties meet reasonable safe driving standards. If driving is an essential part of my job description, I understand that any employment is conditioned on a good DMV record and maintenance of the minimum standard of auto insurance as specified by the State of California. A DMV check is made on such new hires as a condition of employment and annually thereafter. We check for safe driving record standards during the past thirty-six (36) months which is as follows:

No more than three (3) moving violations; or no more than one chargeable accident; or no major charges such as reckless driving, driving while intoxicated/driving under the influence of drugs in the past five (5) years, etc.
Staff whose driving record exceeds the above standards will be notified. Those individuals may be required to provide evidence of higher limits of auto liability insurance on their own vehicle.

I, hereby, authorize the company and/or its agents, including information-reporting bureaus (DMV), to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, law enforcement authorities and the Agency from any liability for any damage whatsoever for issuing this information.

RESPONSIBILITY FOR ITEMS FURNISHED TO THE EMPLOYEE

In many positions throughout the Agency, company property is assigned for employees to use. These materials include but are not limited to address books, photocopies with names, addresses and telephone numbers of persons and/or facilities associated with the Agency, pagers, office keys, mobile phones, medical supplies, patient care equipment and office equipment. Any employee receiving such items will return them to the Agency in good condition, reasonable wear and tear accepted, at the termination of employment. If such item is not returned on time, the reasonable value of the item may be claimed against the employee and the employee agrees that its reasonable value may be deducted from his/her pay. The Agency assumes no responsibility for lost or stolen items of employees. Employees are encouraged to keep only “essential” items on their person, in the office or in the car.

CELLULAR PHONE USE

I understand that Aven Care Providers does not permit employees on company time to talk or text using cellular phones while driving a vehicle. This is very dangerous and should be avoided at all times. It is mandatory that I must pull over and stop the vehicle each time I conduct agency business via a cellular phone. The agency is not responsible for any moving violations, accidents or other incident that may occur while using a cellular phone and driving.

HEALTH SCREENING

If my job description includes direct patient care, I understand that any employment is conditioned on submission of a current (within 6 months) written health assessment report which verifies that I am free from health conditions which would interfere with my ability to perform assigned duties. The report will also verify that I am free from signs or symptoms of infectious diseases. If employed, I agree to submit a medical examination at any time deemed appropriate by the Agency and as permitted by law.

RELEASE OF DOCUMENTS

I understand that the Agency may provide a copy of my Specialty License(s), CPR card, Health Screening, Immunizations, Vaccinations, Fire and Safety card, Driver’s License, Academic Transcripts/Educational Qualification(s), and other personnel information, if requested, to authorized representatives of those organizations with which the Agency has contracts.

DISCLAIMER AND WAIVER OF LIABILITY

I acknowledge and will adhere to the rules and regulations as set forth by the Agency’s Clients. I understand that the falsification of documents, particularly those pertaining to the submission of visit notes, where in fact no visit was made, is considered to be fraud and is subject to filing of a criminal grievance, civil and/or criminal prosecution, and immediate termination. I, therefore, hold the Agency, its shareholders, directors and officers, harmless from any falsified documents.

ILLEGAL SOLICITATION AND REMUNERATION

Individuals employed by or under contract shall not willfully nor knowingly solicit, offer, receive or pay any remuneration including bribes, rebates or kickbacks directly or indirectly, overtly or covertly, in cash or in kind, in order to induce the referral of Clients whose care is reimbursed under any Federal or State Care Program.

HEALTH AND SAFETY AGREEMENT

I do understand the physical requirements of my job and understand proper lifting and moving techniques which I am expected to use in moving and lifting objects and/or patients. I have been informed and do fully understand that any injury claimed by me while on the job must be reported immediately to my supervisor and documented on an Accident/Incident Report form. I understand that unless an incident report is completed immediately and signed by me, the agency may not consider a voluntary payment of any medical bills or any other benefits as a result of my injury. I further understand that if the accident/injury is proven to be a result of my failing to follow policy/procedure, the agency may not be expected to cover medical payments. I do fully understand that I am not encouraged to lift or transfer any object or patient by myself unless I know that I can safely lift or transfer alone. If I believe there is no one readily available to assist me in lifting or moving patients or equipment while on duty, I am to wait until I can obtain assistance before moving or lifting.

AVEN CARE PROVIDERS AS AN "AT-WILL EMPLOYER."

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and I may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Agency. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Agency unless made in writing by the Executive Director. I will comply with all rules and policies of the Agency.

EMPLOYEE HANDBOOK

I have received and read the contents of the current Employee Handbook. I understand that the contents of the aforementioned Handbook may be changed, altered, and otherwise modified at the discretion of the Agency. I agree to adhere to the policies enunciated therein.

PAY PERIOD IS BI-MONTHLY

Aven Care Providers runs a bi-monthly payroll cycle. Paydays are on the 5th and 20th of every month but are subject to change by the Agency with notification.

By checking the box below, I confirm that I have read the above and fully understand these requirements. I agree to abide by the policies, regulations and requirements of Aven Care Providers. *

I confirm that I have read the above and I agree to abide by the policies, regulations and requirements of Aven Care Providers.

JOB DESCRIPTION SUMMARY

PERSONAL CARE ASSISTANT JOB SUMMARY

POSITION SUMMARY

The Personal Care Assistant (PCA )/Home Care Aide (HCA) is a paraprofessional member of the private duty team who works under the supervision of a care coordinator and performs various personal care and support services as necessary to meet the client’s needs. The Personal Care Assistant/Home Care Aide is responsible for observing clients, reporting and recording these observations and documenting the services provided.

The Personal Care Assistant/Home Care Aide will be assigned in a manner that promotes quality, continuity and safety of services.

Reports to: Case Manager/Client Care Coordinator/RN/LVN

POSITION QUALIFICATIONS

Is a Home Care Aide or has demonstrated competency as defined in Agency policies.
Is at least 18 years of age.
Possesses and maintains good physical stamina and mental health.
Presents a pre-employment physician's health clearance, including negative TB skin tests or CXR and other tests as required by State of California Statute.
Possess and maintains current CPR certification.
Pass criminal clearance through the HCA Registry/CDSS Trustline.
Has ability to read, follow written instructions, and document services provided.
Is self-directed with the ability to work with little direct supervision.
Has empathy for the needs of the ill, injured, frail and impaired.
Is flexible and cooperative in fulfilling role obligation.
Demonstrates tact, patience and good personal hygiene.
Attend Orientation/Training/Meetings as required by Agency.
Must be a licensed driver with an insured automobile and is in good working order. OR Must maintain a safe and efficient method of transportation aimed at arriving to work as scheduled.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

Responsibilities of the Personal Care Assistant include, but are not limited to:
Providing personal care including:
- Baths
- Back rubs
- Oral hygiene
- Shampoos
- Changing bed linen
- Dressing and undressing clients
- Skin care and prevention of skin breakdown
- Toileting activities
- Keeping the client’s living area clean and orderly, as appropriate
Planning and preparing nutritious meals.
Assisting in feeding the client, if necessary.
Taking and recording oral, rectal and auxiliary temperatures, pulse, respiration and blood pressure when ordered (within the training limitations of the personal care assistant).
Assisting in ambulation and exercise according to the service delivery plan.
Performing range of motion and other simple procedures as ordered (within the training limitations of the personal care assistant).
Assisting the client in the self-administration of medication.
Doing the client’s laundry, as appropriate.
Meeting the safety needs of clients and using equipment safely and properly (foot stools, side rails, restraints, etc.).
Reporting the client’s condition and significant changes to the assigned care coordinator or supervisor.
Adhering to documentation and care procedures and standards of personal and professional conduct.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.

PHYSICAL/ENVIRONMENTAL DEMANDS

Visual/hearing ability sufficient to comprehend written/verbal communication.
Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing.
Ability to deal effectively with stress.
Able to work a minimum of 40 hours per week.
Able to bend and stand an average of 8 hours per day.
Able to lift, pull, push, or carry up to 50-75 pounds.
Able to write up to 3 hours per day.
Able to work in a stressful environment.
Able to drive 50-100 miles per day in all weather conditions.
Able to assess and communicate with ill patients, co-workers, and general public.
Potential for exposure to infectious disease
Ability to manage clinical equipment/machines
Providing services in a variety of environments
Walking on a variety of surfaces
Is neat in appearance and practice, with good personal hygiene

JOB LIMITATIONS

The Personal Care Assistant/Home Care Aide will not function in any manner viewed as the practice of nursing according to the State's Nurse Practice Act. Specifically, the Personal Care Assistant/Home Care Aide will not administer medications, take physician's orders or perform procedures requiring the training, knowledge and skill of a nurse, specifically sterile techniques. The Personal Care Assistant/Home Care Aide provides non-skilled, non-medical functions only.

CERTIFIED NURSES' JOB SUMMARY

POSITION SUMMARY

The Nurse Assistant is a paraprofessional member of the home care team who works under the supervision of a Registered Nurse/Case Manager or Therapist and performs various services for a patient as necessary to meet the patient’s personal needs, to promote the patient’s comfort, and a safe environment. The nurse assistant is responsible for observing patients and reporting/documenting these observations and the services provided.

Reports To: Case Manager/Nursing Supervisor/Client Care Coordinator

POSITION QUALIFICATIONS

Successful completion of a formal Nurse Assistant certification training program and/or a written skills test and competency evaluation.
Current certification issued by the California Department of Public Health
Be at least eighteen (18) years of age.
Minimum of six (6) months work experience in a supervised setting, preferably health care facility or direct patient care in a hospital or nursing home setting or evidence of sympathetic attitude toward care of the sick.
Displays initiative and able to work with minimal direct supervision.
Demonstrates tact, patience, and good personal hygiene.
Possesses and maintains current CPR certification.
Must receive at least 12 hours in-service training in every 12-month period
Demonstrated ability to read, write, and follow a written Plan of Care.
Good interpersonal skills.
Maintain Annual Physical Examination, TB test and any other required conditions of engagement and submit necessary updates to HR.
Must be a licensed driver with an insured automobile and is in good working order. OR must maintain a safe and efficient method of transportation aimed at arriving to work as scheduled.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

Responsibilities of the nurse assistant include, but are not limited to, the following:

Providing personal care including:
- Baths
- Back rubs
- Oral hygiene
- Shampoos
- Changing bed linen
- Assisting the patient with dressing and undressing
- Skin care to prevent breakdown
- Assisting the patient with toileting activities
- Keeping patient’s living area clean and orderly
Planning and preparing nutritious meals.
Assisting in feeding the patient, if necessary.
Taking and recording oral, rectal and axillary temperatures, pulse, respiration and blood pressure when ordered (with appropriate completed/demonstrated skills competency).
Assisting in ambulation and exercise according to the plan of care.
Performing range of motion and other simple procedures as an extensional therapy service as ordered (with appropriate completed/demonstrated skills competency).
Assisting patient in the self-administration of medication.
Doing patient’s laundry, as appropriate.
Meeting safety needs of patients and using equipment safely and properly (foot stools, side rails, etc.).
Reporting on patient’s condition and significant changes to the assigned supervisory nurse.
Adhering to the Organization's documentation and care procedures and standards of personal and professional conduct.

PHYSICAL/ENVIRONMENTAL DEMANDS

Visual/hearing ability sufficient to comprehend written/verbal communication.
Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing.
Ability to deal effectively with stress.
Able to work a minimum of 40 hours per week.
Able to bend and stand an average of 8 hours per day.
Able to lift, pull, push, or carry up to 50-75 pounds.
Able to write up to 3 hours per day.
Able to work in a stressful environment.
Able to drive 50-100 miles per day in all weather conditions.
Able to assess and communicate with ill patients, co-workers, and general public.
Potential for exposure to infectious disease
Ability to manage clinical equipment/machines
Providing services in a variety of environments
Walking on a variety of surfaces
Is neat in appearance and practice, with good personal hygiene

CERTIFIED HOME HEALTH AIDE JOB SUMMARY

POSITION SUMMARY

Provides direct patient care and personal care services under the direction of the Registered Nurse or Therapist. The Certified Home Health Aide is assigned to specific clients by the Registered Nurse or other appropriate professional and performs services for clients as necessary to maintain their personal comfort.

Reports to: Case Manager/Nursing Supervisor/Client Care Coordinator

POSITION QUALIFICATIONS

Successful completion of a formal Certified Home Health Aide certification training program and/or a written skills test and competency evaluation.
Current certification issued by the California Department of Public Health
Be at least eighteen (18) years of age.
Minimum of six (6) months work experience in a supervised setting, preferably health care facility or direct patient care in a hospital or nursing home setting or evidence of sympathetic attitude toward care of the sick.
Displays initiative and able to work with minimal direct supervision.
Demonstrates tact, patience, and good personal hygiene.
Possesses and maintains current CPR certification.
Must receive at least 12 hours in-service training in every 12-month period
Demonstrated ability to read, write, and follow a written Plan of Care.
Good interpersonal skills.
Maintain Annual Physical Examination, TB test and any other required conditions of engagement and submit necessary updates to HR.
Must be a licensed driver with insured automobile and is in good working order or must maintain a safe and efficient method of transportation aimed at arriving to work as scheduled.

MAY BE EMPLOYED BY THE AGENCY IF HE/SHE HAS MET THE FOLLOWING ADDITIONAL CONDITIONS:

Home Health Aide is expected to pass competency examination with at least a 80% or better. The content of the competency evaluation of the agency will include but is not limited to:

Communication skills
Observation, reporting, and documentation of a client’s status and the care or service furnished
Reading and recording temperatures, pulse, and respiration, and blood pressures
Basic infection control procedures and instruction on universal precautions
Basic elements of body functions and changes in body function that must be reported to the supervisor
Maintenance of a clean, healthy, and safe environment
Recognizing emergencies and knowledge of emergency procedures
The physical, emotional, and developmental needs of and ways to work with the populations served by the agency including, the need for respect for the client and his or her privacy and property
Appropriate and safe techniques in personal hygiene and grooming that include:
- Bed bath
- Sponge, tub, or shower bath
- Shampoo in sink, tub or bed
- Nail and hair care
- Oral hygiene
- Toileting and eliminating
- Safe transfer techniques and ambulation
- Normal range of motions and positioning
- Adequate nutrition and fluid intake
- Patient rights
- Any other tasks that the agency may choose to have the home health aide perform

ESSENTIAL FUNCTIONS/AREAS OF ACCOUNTABILITY

Performs simple procedures as an extension of therapy services under the direction and supervision of the therapist.
- Range of motion exercises
- Assistance in ambulation or exercises
Performs personal care activities, including but not limited to:
- Bathing
- Shampooing
- Skin Care/nail care
- Oral hygiene
- Shaving
- Dressing
Performs household services essential to health care at home, including but not limited to:
- Meal preparation/feeding
- Laundry
- Light housekeeping
Reports any observed or reported changes in the client’s condition and/or needs to the Registered Nurse.
Documents cares provided and completes the forms required for the client’s records. Completes the appropriate records to document cares given and pertinent observations.
Promotes personal safety and a safe environment for clients by observing infections control practices, following agency guidelines, and reporting unsafe situations to the Supervisor/Case Manager.
Demonstrate safe practice in the use of equipment. Does not use equipment until orientation has been provided. Notifies supervisor of educational needs.
Communicates effectively with all members of the interdisciplinary team through verbal reports, participation in staff meetings, and team conferences, as requested.
Maintains confidentiality in all aspects of the job.
Participates in required in-service programs to meet compliance requirements. Identifies learning needs to agency supervisor.
Performs other related duties and responsibilities as deemed necessary.

PHYSICAL/ENVIRONMENTAL DEMANDS

Visual/hearing ability sufficient to comprehend written/verbal communication.
Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing.
Ability to deal effectively with stress.
Able to work a minimum of 40 hours per week.
Able to bend and stand an average of 8 hours per day.
Able to lift, pull, push, or carry up to 50-75 pounds.
Able to write up to 3 hours per day.
Able to work in a stressful environment.
Able to drive 50-100 miles per day in all weather conditions.
Able to assess and communicate with ill patients, co-workers, and general public.
Potential for exposure to infectious disease
Ability to manage clinical equipment/machines
Providing services in a variety of environments
Walking on a variety of surfaces
Is neat in appearance and practice, with good personal hygiene

DIRECT SUPPORT PROFESSIONAL JOB SUMMARY ONE

POSITION SUMMARY

The Direct Support Professional provides skills training and support to people with intellectual/developmental disabilities in a home environment in areas of deficiency to meet the Consumers’ goals in order to increase or maintain Consumer’s capacity for independent functioning, self-determination, interdependence, productivity and integration in the community.

Reports to: Program Manager/Client Care Coordinator/Case Manager, or Designee

POSITION QUALIFICATIONS

Be at least 18 years old.
Possess a High School Diploma/GED.
Have at least six months experience working for Clients with mental/physical or behavioral disabilities, or
Have undergone CDDS certified Direct Support Professional Year One Training.
CPR and First Aid Certification.
Clear Criminal Background Record Checked by Department of Justice/CDSS Home Care Aide Registry required prior to providing direct service to any Consumer.
Immigration Employment Eligibility.
Maintain an approved Health Screening Clearance performed 6 months prior to employment or 14 days upon employment.
Maintain an approved Proof of negative TB (Mantoux) Skin Test/Chest X-Ray.
California Drivers License and valid insurance may be required under certain circumstances.
Mode of transportation.
Must be of good integrity and possess adequate physical, mental, and emotional stability so as to provide services in a safe and responsible manner.
Ability to employ active listening, critical thinking and teaching skills to assist and support the Consumer.
Must be able to communicate in the language that is functionally required by the individual or make use of specific augmentative communication system utilized by the individual.
Must meet the competencies specified for Direct Support Staff.
Must have the ability to read and carry out the requirements in an ISP.
Able to establish priorities, work independently, and proceed with objectives without hands-on supervision.
Must be willing to work non-traditional hours (as required) (evenings, weekends, holidays), to meet the needs of the Consumer being served.
Other required conditions of engagement and submit necessary updates to HR.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

Implement assigned Consumer's Individual Service Plan, Behavior Support Plans, Medical Support Plans and established protocols consistently.
Participate as a team member in the development of the Consumer's ISP.
Perform all necessary personal care, hygiene, physical support, and daily living needs.
Prepare nutritious meals and snacks according to the dietary needs and preferences of Consumers.
Accurately dispense and document medications and administer treatments as prescribed.
Implement “range of motion”, planned exercise, leisure and recreation activities.
Minimize risks of endangerment to the health, safety and well-being of each assigned Consumers.
Perform First Aid and CPR as needed.
Train on 24-hour Emergency Assistance Systems as appropriate to specific Consumer and take emergency precautions in disaster and earthquake circumstances.
Establish and maintain a constructive and appropriate personal relationship with consumers.
Conduct skills trainings to achieve the intended results for the Consumers.
Record all behavioral data, daily activities as prescribed in the ISP and special incidents.
Knows and follows infection control policies including proper hand-washing techniques.
Ensure proper handling and documentation of Consumer specific/program funds used or transferred during work shift.
Respect the Consumer’s right to privacy, confidentiality and property and treats Consumers and families with respect.
If the Direct Support Professional is also acting as “job coach” with Consumers served:
- Notify the employer of Consumer served of any absences
- Complete all required paperwork and communicate on employment status
- Provide all necessary support and supervision during job/job process for Consumer served, including teaching and modeling job tasks
Cooperate and participate professionally with team members, health professionals, consultants, parents, guardians, and other interested parties.
Maintains appropriate communication with Supervisor (written and verbal) and with all other appropriate Agency line staff.
Punctually observe scheduled work using unscheduled absences only when necessary for illness or emergency.
Accepts and fulfills assignments with the Agency and exercises judgment in accepting assignments.
Attend all in-service trainings and staff meetings.
Assist in training new staff as required.

PHYSICAL/ENVIRONMENTAL DEMANDS

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties, the employee is:

Occasionally = up to 1/3 shift

Frequently = up to 2/3 shift

Continuously = throughout shift

Standing: Continuously in combination with walking indoors and outdoors.
Sitting: Occasionally
Walking: Continuously in combination with standing.
Worker Mobility: Can change positions frequently throughout work shift.
Carry/Lift: Occasionally and independently lift and carry 0-45 pounds.
Pushing/Pulling: Frequently and independently push/pull people served during dressing, transferring or positioning. Frequently and independently push/pull wheelchairs or lifting equipment and occasionally while performing routine household and/or yard tasks.
Bending/Squatting: Frequently throughout the work shift while attending to people served and cleaning.
Reaching/Handling: Use of fingers/hands/arms continuously. Occasional overhead reaching needed.
Grasping/Squeezing: Frequently throughout work shift.
Twisting: Frequently throughout work shift.
Climbing: Occasionally ascend or descend stairs or ramps indoors or outdoors.
Crawling: 0% of the time.
Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.

Social Skill Requirements

Ability to positively interact with Consumers and Co-workers.
Ability to effectively send and receive verbal communication using the English language.
Ability to direct and coordinate the work of Consumer served.

Aptitude Requirements

Must be able to read English and write it legibly.
Able to perform basic math functions.
Must have the ability to analyze, reason, and make decisions.
Must be able to learn and retain new skills.
If person served is working, work with the employer to plan/schedule work activities and use time efficiently and fulfill employer/shift expectations.
Must be adaptable with frequent change, delay, or unexpected events.

Environmental Factors

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job in specific home environment(s) and out in the surrounding communities, as dictated by the needs of the individual(s) requiring support. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Most work is performed in Consumer's home or in the community as a social or employment experience.
Occasional exposure to outside elements.
Possible exposure to chemicals and/or compounds throughout work shift.

This position summary covers most of the duties performed; however, other duties and responsibilities not listed may be assigned at the discretion of Management.

DIRECT SUPPORT PROFESSIONAL JOB SUMMARY TWO

POSITION SUMMARY

Reports to: Program Manager/Client Care Coordinator/Case Manager, or Designee

POSITION QUALIFICATIONS

Be at least 18 years old.
Possess a High School Diploma/GED.
Have at least six months experience working for Clients with mental/physical or behavioral disabilities, or
Have undergone CDDS certified Direct Support Professional Year One Training.
CPR and First Aid Certification.
Clear Criminal Background Record Checked by Department of Justice/CDSS Home Care Aide Registry required prior to providing direct service to any Consumer.
Immigration Employment Eligibility.
Maintain an approved Health Screening Clearance performed 6 months prior to employment or 14 days upon employment.
Maintain an approved Proof of negative TB (Mantoux) Skin Test/Chest X-Ray.
California Drivers License and valid insurance may be required under certain circumstances.
Mode of transportation.
Must be of good integrity and possess adequate physical, mental, and emotional stability so as to provide services in a safe and responsible manner.
Ability to employ active listening, critical thinking and teaching skills to assist and support the Consumer.
Must be able to communicate in the language that is functionally required by the individual or make use of specific augmentative communication system utilized by the individual.
Must meet the competencies specified for Direct Support Staff.
Must have the ability to read and carry out the requirements in an ISP.
Able to establish priorities, work independently, and proceed with objectives without hands-on supervision.
Must be willing to work non-traditional hours (as required) (evenings, weekends, holidays), to meet the needs of the Consumer being served.
Other required conditions of engagement and submit necessary updates to HR.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

Implement assigned Consumer's Individual Service Plan, Behavior Support Plans, Medical Support Plans and established protocols consistently.
Participate as a team member in the development of the Consumer's ISP.
Perform all necessary personal care, hygiene, physical support, and daily living needs.
Prepare nutritious meals and snacks according to the dietary needs and preferences of Consumers.
Accurately dispense and document medications and administer treatments as prescribed.
Implement “range of motion”, planned exercise, leisure and recreation activities.
Minimize risks of endangerment to the health, safety and well-being of each assigned Consumers.
Perform First Aid and CPR as needed.
Train on 24-hour Emergency Assistance Systems as appropriate to specific Consumer and take emergency precautions in disaster and earthquake circumstances.
Establish and maintain a constructive and appropriate personal relationship with consumers.
Conduct skills trainings to achieve the intended results for the Consumers.
Record all behavioral data, daily activities as prescribed in the ISP and special incidents.
Knows and follows infection control policies including proper hand-washing techniques.
Ensure proper handling and documentation of Consumer specific/program funds used or transferred during work shift.
Respect the Consumer’s right to privacy, confidentiality and property and treats Consumers and families with respect.
If the Direct Support Professional is also acting as “job coach” with Consumers served:
- Notify the employer of Consumer served of any absences
- Complete all required paperwork and communicate on employment status
- Provide all necessary support and supervision during job/job process for Consumer served, including teaching and modeling job tasks
Cooperate and participate professionally with team members, health professionals, consultants, parents, guardians, and other interested parties.
Maintains appropriate communication with Supervisor (written and verbal) and with all other appropriate Agency line staff.
Punctually observe scheduled work using unscheduled absences only when necessary for illness or emergency.
Accepts and fulfills assignments with the Agency and exercises judgment in accepting assignments.
Attend all in-service trainings and staff meetings.
Assist in training new staff as required.

PHYSICAL/ENVIRONMENTAL DEMANDS

Physical Requirements

Occasionally = up to 1/3 shift

Frequently = up to 2/3 shift

Continuously = throughout shift

Standing: Continuously in combination with walking indoors and outdoors.
Sitting: Occasionally
Walking: Continuously in combination with standing.
Worker Mobility: Can change positions frequently throughout work shift.
Carry/Lift: Occasionally and independently lift and carry 0-45 pounds.
Pushing/Pulling: Frequently and independently push/pull people served during dressing, transferring or positioning. Frequently and independently push/pull wheelchairs or lifting equipment and occasionally while performing routine household and/or yard tasks.
Bending/Squatting: Frequently throughout the work shift while attending to people served and cleaning.
Reaching/Handling: Use of fingers/hands/arms continuously. Occasional overhead reaching needed.
Grasping/Squeezing: Frequently throughout work shift.
Twisting: Frequently throughout work shift.
Climbing: Occasionally ascend or descend stairs or ramps indoors or outdoors.
Crawling: 0% of the time.
Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.

Social Skill Requirements

Ability to positively interact with Consumers and Co-workers.
Ability to effectively send and receive verbal communication using the English language.
Ability to direct and coordinate the work of Consumer served.

Aptitude Requirements

Must be able to read English and write it legibly.
Able to perform basic math functions.
Must have the ability to analyze, reason, and make decisions.
Must be able to learn and retain new skills.
If person served is working, work with the employer to plan/schedule work activities and use time efficiently and fulfill employer/shift expectations.
Must be adaptable with frequent change, delay, or unexpected events.

Environmental Factors

Most work is performed in Consumer's home or in the community as a social or employment experience.
Occasional exposure to outside elements.
Possible exposure to chemicals and/or compounds throughout work shift.

This position summary covers most of the duties performed; however, other duties and responsibilities not listed may be assigned at the discretion of Management.

LICENSED VOCATIONAL NURSE JOB SUMMARY

POSITION SUMMARY

Performs skilled nursing functions in accordance with the federal, state, and local laws and within the guidelines of his/her professional organization and agency. All functions shall be performed in accordance with the established policies and practices according to the California State Nurse Practice Act. The LVN delivers care to clients as delegated by the RN Nursing Supervisor.

Reports to: RN Case Manager/Nursing Supervisor/Clinical Supervisor/Director of Patient Care Services

QUALIFICATIONS

Graduate of an accredited school of professional nursing.
Current license to practice as a Licensed Vocational Nurse issued by the California Board of Vocational Nurse and Psychiatric Technician Examiners.
Minimum of one (1) year of experience in an acute care setting or equivalent experience.
CPR certified.
Effective written and verbal communication skills.
Good interpersonal communication skills.
Current driver’s license, good driving record, and reliable transportation.
Maintain Annual Physical Examination, TB test and any other required conditions of engagement and submit necessary updates to HR.

ESSENTIAL FUNCTIONS/AREAS OF ACCOUNTABILITY

Provides professional nursing care under the direction of a Registered Nurse. Communicates appropriate status/condition changes to the RN per agency guidelines.
Provides skilled nursing visits for clients as directed by the RN Nursing Supervisor. Follows the care plan established by the Registered Nurse.
Recognizes and reports changes in client condition to the Nursing Supervisor and physician, as directed.
Communicates information on a timely basis, consistent with agency policy and urgency of the situation. Communication is verbal, as needed, and through complete and accurate documentation in the clinical record.
Scope of clinical practice includes personal care services, assessment of findings, medication monitoring and administration, client teaching, emergency intervention, and nursing services within professional scope of practice and as delegated by the Nursing Supervisor.
Promotes personal safety and a safe environment for clients and coworkers:
- Demonstrates knowledge of safety/infection control practices by compliance with policies and procedures.
- Recognizes and responds appropriately to potentially unsafe situations.
- Demonstrates safe practice in the use of equipment.
- Makes recommendations on improvement of safety.
Performs job in compliance with agency policies and procedures and professional and community standards:
- Accepts responsibility for professional nursing role.
- Follows applicable state and federal laws and agency standards.
- Attends all meetings as required.
- Maintains confidentiality in all aspects of the job.
- Refrains from discussing client or staff identities, conditions, or circumstances in public or with others who do not have a legitimate interest in the person.
- Participates in the development, implementation, and evaluation of the Agency Quality Improvement Program and pertinent activities.
Performs other related duties and responsibilities as deemed necessary.

PHYSICAL/ENVIRONMENTAL DEMANDS

Visual/hearing ability sufficient to comprehend written/verbal communication.
Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing.
Ability to deal effectively with stress.
Able to work a minimum of 40 hours per week.
Able to bend and stand an average of 8 hours per day.
Able to lift, pull, push, or carry up to 50-75 pounds.
Able to write up to 3 hours per day.
Able to work in a stressful environment.
Able to drive 50-100 miles per day in all weather conditions.
Able to assess and communicate with ill patients, co-workers, and general public.
Potential for exposure to infectious disease.
Ability to manage clinical equipment/machines.
Providing services in a variety of environments.
Walking on a variety of surfaces.
Is neat in appearance and practice, with good personal hygiene.

REGISTERED NURSE JOB SUMMARY

POSITION SUMMARY

Provides services to clients in accordance with California State Nurse Practice Act, agency policy, and accepted professional standards of practice. The Registered Nurse provides nursing services utilizing a comprehensive base of nursing theory and nursing process, and communicates/documents observations and assessment.

Reports to: Nursing Supervisor/Clinical Supervisor/Director of Patient Care Services

QUALIFICATIONS

Graduate of an accredited school of professional nursing or Baccalaureate degree in Nursing.
Current license as a Registered Nurse issued by the California Board of Registered Nursing.
Minimum of one (1) year experience in an acute care setting or equivalent experience.
Current driver's license, good driving record, and reliable transportation.
CPR certification
Strong communication and interpersonal skills.
Maintain Annual Physical Examination, TB test and any other required conditions of engagement and submit necessary updates to HR.

ESSENTIAL FUNCTIONS/AREAS OF ACCOUNTABILITY

Assumes Responsibility and accountability for the practice of professional nursing in accordance with California State Nurse Practice Act and standards for home health nursing:
- Performs comprehensive assessments of client status, including physical, psycho-social and environmental parameters.
- Develops and/or follows an individualized Plan of Care that incorporates analysis of data current scientific findings.
- Provides skilled interventions aimed at achieving realistic client outcomes within a specified time period.
- Reports changes and information necessary to modify and update the care plan to reflect progress towards goals (outcomes).
Consistently demonstrates competency with technical nursing skills according to personal and legal scope of practice:
- Assessment skill as applied to the client, family/support system, and environment.
- Teaching skills according to the client's needs and within the context of the Client’s environment, value system, and physical/emotional status.
- Medication administrations.
Practices nursing with respect for individual, cultural, and spiritual differences.
Communicates effectively and in accordance with agency requirements:
- Reports significant changes in client status to the physician and other members of the team in a timely manner consistent with client needs.
- Maintains client records showing systematic assessment, planning, intervention, and evaluation.
- Documents legibly and according to agency documentation guidelines and standards.
Initiates actions to improve the quality of patient care. Takes appropriate actions independently and responsively in home health care situations. Initiates referrals as needed to other health team members when delegated by the Nursing Supervisor.
Maintains confidentiality in all aspects of the job.
Promotes personal safety and a safe environment for clients and co-workers:
- Demonstrates knowledge of safety/infection control practices by Compliance with established policies and procedures.
- Recognizes and responds appropriately to potentially unsafe situations.
- Demonstrates safe practice in the use of equipment.
- Assesses safety of environment and takes initiative to help prevent accidents and promote safety.
Participates in ongoing, professional self-development:
- Participates in all mandatory education per agency guidelines.
- Identifies needs for personal professional growth.
- Demonstrates competency in areas of assignment or identifies the need for additional training (pediatrics, infusion, specialized equipment, etc.)
Supervises applicable home health care team members as delegated by RN Nursing Supervisor.
Performs other duties as assigned.

PHYSICAL/ENVIRONMENTAL DEMANDS

Visual/hearing ability sufficient to comprehend written/verbal communication.
Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing.
Ability to deal effectively with stress.
Able to work a minimum of 40 hours per week.
Able to bend and stand an average of 8 hours per day.
Able to lift, pull, push, or carry up to 50-75 pounds.
Able to write up to 3 hours per day.
Able to work in a stressful environment.
Able to drive 50-100 miles per day in all weather conditions.
Able to assess and communicate with ill patients, co-workers, and general public.
Potential for exposure to infectious disease
Ability to manage clinical equipment/machines
Providing services in a variety of environments
Walking on a variety of surfaces
Is neat in appearance and practice, with good personal hygiene

By checking the box below, I confirm that I have read and understand the above job description of Personal Care Assistant *

I confirm that I have read and understand the above job description of Personal Care Assistant

By checking the box below, I confirm that I have read and understand the above job description of Certified Nurse Aide *

I confirm that I have read and understand the above job description of Certified Nurse Aide

By checking the box below, I confirm that I have read and understand the above job description of Certified Home Health Aide *

I confirm that I have read and understand the above job description of Certified Home Health Aide

By checking the box below, I confirm that I have read and understand the above job description of Direct Support Professional (DSP) ONE *

I confirm that I have read and understand the above job description of Direct Support Professional (DSP) ONE

By checking the box below, I confirm that I have read and understand the above job description of Direct Support Professional (DSP) TWO *

I confirm that I have read and understand the above job description of Direct Support Professional (DSP) TWO

By checking the box below, I confirm that I have read and understand the above job description of Licensed Vocational Nurse *

I confirm that I have read and understand the above job description of Licensed Vocational Nurse

By checking the box below, I confirm that I have read and understand the above job description of Registered Nurse *

I confirm that I have read and understand the above job description of Registered Nurse

JOB ACCEPTANCE

I have received the applicable job description(s), I hereby accept the job.

I have read and consented to comply with the Agency’s policies and procedures.

I further understand and agree that my employment/contract is “At Will” and without fixed terms, that I may be terminated at any time, with or without prior notice, at the option of either myself or the Agency.

No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the Agency unless made in writing by the Executive Director of the Agency.

Full Name *

Date

Agency Rep. Full Name

Email

info@avencareproviders.com

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855.505.5480

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PERSONAL INFORMATION

HOME ADDRESS INFORMATION

CONTACT INFORMATION

Position Applying For and Availability

EDUCATION (include city/state/country)-begin with last school attended

EMPLOYMENT HISTORY

PERSONAL REFERENCES

PROFESSIONAL LICENSE / CERTIFICATIONS

TRAINING

EQUAL EMPLOYMENT OPPORTUNITY

APPLICANT DATA FORM

CONFIDENTIALITY AGREEMENT

NON-COMPETE AGREEMENT

AGENCY FEE

POLICY ON NON-DISCRIMINATION AND SEXUAL HARASSMENT

CIVIL RIGHTS

Definition:

DRUG ABUSE POLICY

STATEMENT OF PURPOSE AND SCOPE

DEFINITION OF DRUG

CONSEQUENCES OF VIOLATION

ADULT/ CHILD/ DISABLED ABUSE

OSHA BLOODBORNE PATHOGENS STANDARDS

AREAS OF IMPLEMENTATION OF THE PLAN

EXPOSURE DETERMINATION

SUBMISSION OF DOCUMENTATION AGREEMENT

POLICY & PROCEDURE ON EMPLOYEE GRIEVANCE

HEPATITIS B VACCINE

EMPLOYEE HEALTH QUESTIONNAIRE

HAVE YOU EVER HAD ANY OF THE FOLLOWING:

POLICY ACKNOWLEDGEMENTS

SAFE DRIVING STANDARD

RESPONSIBILITY FOR ITEMS FURNISHED TO THE EMPLOYEE

CELLULAR PHONE USE

HEALTH SCREENING

RELEASE OF DOCUMENTS

DISCLAIMER AND WAIVER OF LIABILITY

ILLEGAL SOLICITATION AND REMUNERATION

HEALTH AND SAFETY AGREEMENT

AVEN CARE PROVIDERS AS AN "AT-WILL EMPLOYER."

EMPLOYEE HANDBOOK

PAY PERIOD IS BI-MONTHLY

JOB DESCRIPTION SUMMARY

PERSONAL CARE ASSISTANT JOB SUMMARY

POSITION SUMMARY

POSITION QUALIFICATIONS

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

PHYSICAL/ENVIRONMENTAL DEMANDS

JOB LIMITATIONS

CERTIFIED NURSES' JOB SUMMARY

POSITION SUMMARY

POSITION QUALIFICATIONS

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

PHYSICAL/ENVIRONMENTAL DEMANDS

CERTIFIED HOME HEALTH AIDE JOB SUMMARY

POSITION SUMMARY

POSITION QUALIFICATIONS

MAY BE EMPLOYED BY THE AGENCY IF HE/SHE HAS MET THE FOLLOWING ADDITIONAL CONDITIONS:

ESSENTIAL FUNCTIONS/AREAS OF ACCOUNTABILITY

PHYSICAL/ENVIRONMENTAL DEMANDS

DIRECT SUPPORT PROFESSIONAL JOB SUMMARY ONE

POSITION SUMMARY

POSITION QUALIFICATIONS

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

PHYSICAL/ENVIRONMENTAL DEMANDS

Physical Requirements

Social Skill Requirements

Aptitude Requirements

Environmental Factors

DIRECT SUPPORT PROFESSIONAL JOB SUMMARY TWO

POSITION SUMMARY

POSITION QUALIFICATIONS

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

PHYSICAL/ENVIRONMENTAL DEMANDS

Physical Requirements