Home Health Aide (HHA)/ Nurse Aide (NA) Knowledge Test

  • Home Health Aide (HHA)/ Nurse Aide (NA) Knowledge Test

  • Date*
     - -

  • Multiple Choice:

  • 1. The nurse aide is caring for a client who is agitated. The nurse aide should;*
  • 2. When a client has a left-side weakness, what part of a sweater is put on first?*
  • 3. It is appropriate for a nurse aide to share the information regarding a client's status with;*
  • 4. A nurse aide must wear gloves when;*
  • 5. What is the beginning sign of a pressure sore?*
  • 6. When feeding a client, frequent coughing can be a sign the resident is;*
  • 7. The nurse aide is asked by a confused client what day it is. The nurse aide should;*
  • 8. If the nurse aide discovers a fire in the client's room, the first thing to do is;*
  • 9. In order to communicate clearly with a client who has hearing loss, the nurse aide should;*
  • 10. The client offers a nurse aide a twenty dollar bill as a thank you for all that nurse aide has done. The nurse aide should;*
  • 11. The nurse aide finds a conscious client lying on the bathroom floor. The first thing the nurse aide should do is;*
  • 12. A nurse aide notices that a resident has very dry skin on their feet. How should the nurse aide care for the resident's feet?*
  • 13. A nurse aide is caring for a resident on bed rest. The resident is not able to turn herself. What is the longest time that the nurse aide is allowed to leave the resident in one position?*
  • 14. Before assisting a client into a wheelchair, the first action would be to;*
  • 15. Which of the following is true about caring for a person who wears a hearing aid;*
  • 16. If a client objects to a certain food the appropriate action would be to;*
  • 17. The nurse aide is assigned to bathe a resident. What should the nurse aide do FIRST?*
  • 18. A home health aide;*
  • 19. One action that shows you are listening to someone is;*
  • 20. When communicating with the visually impaired you should;*
  • 21. While recording the client care record you should;*
  • 22. Which is not a safety hazard commonly found in homes;*
  • 23. Which statement is false?*
  • 24. When cleaning a client's bathroom you should always;*
  • 25. An example of a food containing fiber is;*
  • 26. When feeding a client you should not;*
  • 27. You should wash your hands after you;*
  • 28. A client needs to be moved up in bed. Do you;*
  • 29. While helping a client ambulate you should;*
  • 30. When making a bed you should;*
  • 31. As you clean dentures, you should do all of the following except;*
  • 32. When using powder on patients you should;*
  • 33. When assisting clients to the commode you should not;*
  • 34. Which is a sign of physical abuse?*
  • 35. Which are you allowed to do when in a client's residence?*
  • 36. Gloves should be wo1n for which of the following procedures?*
  • 37. A resident has diabetes. Which of the following is a common sign of a low blood sugar?*
  • 38. A client who is incontinent of urine has an increase risk of developing*
  • 39. When cleaning the genital area during perineal care, the nurse aide should;*
  • 40. Which of the following is a normal age-related change?*
  • 41. Which of the following is not a good example of body mechanics?*
  • 42. A home health aide should wear all of the following except;*

  • True/False:

  • 43. A home health aide should wash his/her hands before putting on gloves but does not need to wash them once the gloves are removed.*
  • 44. Home health aides are not required to follow the Health Insurance Portability and Accountability Act (HIPPA) guidelines. These rules only apply to nurses and health care providers.*
  • 45. Smoking is allowed in client's homes that are on oxygen.*
  • 46. Client's with Alzheimer's disease may show signs of confusion and may wander.*
  • 47. When lifting a heavy object you should always bend at the waist, rounding your shoulders.*
  • 48. The purpose of cold application is usually to prevent or reduce swelling.*
  • 49. Bathing a client stimulates circulation and removes bacteria.*
  • 50. Too much lotion on a patient is good for their skin.*
  • 51. You should always test the water before giving a client a shower or bath.*
  • 52. An incontinent client is at great risk for skin breakdown.*
  • 53. A client with a pulse rate of 70 beats per minute has a weak pulse.*
  • 54. Home care aides assist clients to take their own medications but never administer medications.*
  • 55. It is important to keep a list of emergency telephone numbers handy.*
  • 56. You should continue to do range of motion exercises even if it hurts the client.*
  • 57. To wash a client’s hair, only water is used.*
  • 58. When shaving a client with an electric razor, apply shave cream to the site you will be shaving.*
  • Date*
     - -
  • Date
     - -

  • Application for Employment

  • Date:*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Birth Date:*
     - -
  • Date available:*
     - -
  • Type of employment desired:*
  • If currently employed, may we contact your employer?*
  • Is there a specific reason you are applying for employment at this company?*
  • Are you legally eligible for employment in this country?*
  • Have you lived in the state of PA for more than 2 years?*
  • Are you available to work overtime if required?*
  • Have you applied with this company before?*
  • Have you been employed at this company before?*
  • Do you have any friends or family employed at this location?*
  • Have you been convicted of a crime in the last seven (7) years?*
  • If considered for hiring, will you agree to provide a criminal background check?*
  • If considered for hiring, will you agree to provide a driver's abstract?*

  • EDUCATIONAL BACKGROUND

  • Rows
  • Rows
  • Rows

  • PLEASE ANSWER THE FOLLOWING QUESTIONS

  • EMPLOYMENT BACKGROUND

    Provide the following information beginning with the most recent employer.
  • Format: (000) 000-0000.
  • MAY WE CONTACT FOR REFERENCE?*
  • DATES EMPLOYED FROM:*
     - -
  • DATES EMPLOYED TO:*
     - -
  • Format: (000) 000-0000.
  • MAY WE CONTACT FOR REFERENCE?*
  • DATES EMPLOYED FROM:*
     - -
  • DATES EMPLOYED TO:*
     - -
  • Format: (000) 000-0000.
  • MAY WE CONTACT FOR REFERENCE?*
  • DATES EMPLOYED FROM:*
     - -
  • DATES EMPLOYED TO:*
     - -
  • Format: (000) 000-0000.
  • MAY WE CONTACT FOR REFERENCE?*
  • DATES EMPLOYED FROM:*
     - -
  • DATES EMPLOYED TO:*
     - -

  • REFERENCES:

  • Rows
  • Date:*
     - -

  • For Office Use Only:

  • Date application received:
     - -
  • Date applicant contacted:
     - -

  • AVAILABILITY

  • Rows

  • EMPLOYEE CONSENT FOR REFERENCE CHECK

  • To Whom It May Concern: 

    I give, *   my former employer, authorization to provide a reference check to my potential employer, Age in Place Home Care. 

    I am aware and acknowledge the information referred to above is not shared with any third parties. By signing below I give the employer consent to collect the 
    information contained herein and use for the purpose specified. 


    Signed:   *   


    Print Name:   *   *   


    Address:   *   *   *   *   *   

  • EMPLOYEE CONSENT FOR REFERENCE CHECK

  • To Whom It May Concern: 

    I give, *   my former employer, authorization to provide a reference check to my potential employer, Age in Place Home Care. 

    I am aware and acknowledge the information referred to above is not shared with any third parties. By signing below I give the employer consent to collect the 
    information contained herein and use for the purpose specified. 


    Signed:   *   


    Print Name:   *   *   


    Address:   *   *   *   *   *   

  • Employee Profile

  • Biography

  • Smoker:*
  • Languages Spoken:*
  • Allergies?:*

  • Leisure Profile

  • LEISURE:*
  • HOBBIES:*
  • SPORTS:*

  • Behavior Profile

  • Rows

  • Home Services Profile

  • Check all areas of client "Home Services" that you have experience working with. Provide notes if required.

  • Light Housekeeping:

  • Check all areas of client Light Housekeeping that you have experience working with.*

  • Laundry:

  • Check all areas of client Laundry that you have experience working with.*

  • Meal Preparation:

  • Check all areas of client Meal Preparation that you have experience working with.*

  • Home Basics:

  • Check all areas of client Home Basics that you have experience working with.*

  • Pet Care:

  • Check all areas of client Pet Care that you have experience working with.*

  • Basic Client Personal Care:

  • Check all areas of Basic Client Personal Care that you have experience working with.*

  • Attendant:

  • Check all areas of client Attendant that you have experience working with.*

  • Experience Profile

  • Rows
  • Experience with these job skills and will perform:*
  • Experience with these conditions/diagnoses:*
  • Experience with or will do these additional job responsibilities: *
  • Experience with this home medical equipment: *
  • Date:*
     - -

  • EMPLOYEE CONSENT FOR INSURANCE CONFIRMATION

  • To Whom It May Concern: 

    I give,   *   my insurance Broker, authorization to release to my employer the following information: 

    • Automobile insurance policy information;
    • Copies of automobile policies and certificates of insurance.

    I also give authorization to advise my employer of any changes in my automobile insurance. 
    I am aware and acknowledge the information referred to above is not shared with any third parties except the employer if requested at any time for audit. The information is used by the employer to confirm adequate and proper insurance coverage of my automobile while being used in the course of my employment. 
    By signing below I give the employer consent to collect the information contained herein and use for the purpose specified. By signing below I also give consent to my insurance broker to provide the employer with the above-mentioned information. 


    Signed: *

    Print Name:    *   * 

    Address:   *   *   *   *   *       

  • CONSENT FOR DRIVER ABSTRACT

  • If you are offered and accept employment with Age in Place Home Care, in the interest of safety for all concerned, you will be required to have the last 3 years of your drivers record pulled. 

    I,   *   *   , have been fully informed of the reason for this, and do hereby freely give my consent. In addition, I understand that the results of this test will become part of my record. 
    I hereby authorize these results to be released to Age in Place Home Care. 

    SELECT ONE OF THE FOLLOWING: 

    *   (Initial) I CONSENT TO HAVE THE LAST 3 YEARS OF MY DRIVERS 

    RECORD REVIEWED 
    Driver's License State:   *   

    Driver's License Number:   *    

    Last 4 digits of Social:    *   

    *   (Initial) I DO NOT HAVE AN ACTIVE DRIVERS LICENSE 

    *   (Initial) I DO HAVE AN ACTIVE DRIVERS LICENSE BUT WILL NOT TRANSPORT CLIENTS. 

    Date:    Pick a Date*   

    Name:   *   *   

    Signature:   *   

    Age in Place Representative Name:    *   *   

    Age in Place Representative Title:    * 

    Age in Place Representative Signature:    *     



    The information contained within this document is not shared with any third parties. The information is for record keeping and is kept in the employee's file during employment or as required by law. The information is used in the employee's confidential record of employment. The Employee, by signing this document gives the employer consent to collect the information contained herein and use for the specified purpose. 

  • CONSENT FOR DRUG/ALCOHOL SCREENING TEST

  • If you are offered and accept employment with Age in Place Home Care, in the interest of safety for all concerned, you will be required to take a urine test for 
    drug and/or alcohol use. 

    I,   *   *   , have been fully informed of the reason for this urine test for drug and/or alcohol (I understand what I am being tested for), the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record. If this test is positive, and for this reason I am not hired, I understand that I will be given the opportunity to explain the results of this test. 

    I hereby authorize these test results to be released to Age in Place Home Care.

    Date:   Pick a Date*   

    Name:   *   *   

    Signature:   *   

    Age in Place Representative Name:    *   *   

    Age in Place Representative Title:   *   

    Age in Place Representative Signature:    *   



    The information contained within this document is not shared with any third parties. The 
    information is for record keeping and is kept in the employee's file during employment or as required by law. The information is used in the employee's confidential record of employment. The Employee, by signing this document gives the employer consent to collect the information contained herein and use for the specified purpose. 

  • Dear Age in Place Employee, 


    The following items are required for employment with our company and payment will be your responsibility. Should be received by check or money order upon hire.



    Background Check ($10) 


    Driver's Abstract ($14)


    The pre-employment testing, which include the Drug Screen & 2 Step PPD, will also be your responsibility; however, Age in Place will pay upfront for this testing and it will later be deducted from your check. The cost of the pre-employment testing will depend on which location you choose.

    I   *   understand the above information regarding the cost to me for my pre-employment testing and background check as well as driver abstract if necessary. 


    Employee Print Name    *   *   


    Employee Signature    *   Date:   Pick a Date*   


    Age in Place Representative    *   Date:   Pick a Date*   

  • Click the link below and complete the questions for the WOTC.
    Work Opportunity Tax Credit

    Please keep a copy of the confirmation code for your records.

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