Home Care

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EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION

Are you a citizen of the United States?
If not, do you have work papers?
Are you a veteran?
Education:
Graduate
Graduate
Graduate
Graduate
Graduate
Previous Employment: (begin with most recent position)


References:
Please furnish the names and addresses of two people to whom you are not related and by whom you have not been employed.



*This is not a test. This is rather a check list to assist us in placing you in appropriate assignments for in home care.
Have you worked in pediatric or neonate intensive care?
Have you worked with ventilators?
Have you had experience with tracheostomies?
Have you had experience with tracheal suctioning
Have you had experience with nasopharyngeal suctioning
Have you worked with NG tubes-continuous feedings?
Have you ever passed a gavage tube?
Have you worked with gastrostomy tubes?
Are you comfortable providing gastrostomy tube feedings?
Have you ever worked with colostomies or ileostomies?
Are you comfortable with adult/pediatric medication administration?
Are you comfortable with calculating pediatric dosages?
Are you comfortable with adult/pediatric IV therapy?
Are comfortable in starting adult/pediatric IV’s
Are you comfortable with angio, butterfly?
Do you have experience with Broviacs or Hickman?
Do you have experience with IV pumps?
Have you experience with or comfortable with CPR
• in adults?
• in children?
Have you experience with or comfortable with CPR ● in infants?

I certify that my answers are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or persons from all liability in responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Maximum upload size: 33.55MB
Maximum upload size: 33.55MB
Maximum upload size: 33.55MB
Maximum upload size: 33.55MB
Maximum upload size: 33.55MB
Maximum upload size: 33.55MB

WHAT TO EXPECT

Maximum upload size: 33.55MB
Maximum upload size: 33.55MB
Maximum upload size: 33.55MB