• Heaven Sent Helpers Application

    for Employment and Contracting
  • Job Description

    Personal Caregivers (PCI/PCII)/ Nurse Aides
  • POSITION SUMMARY:

    The PCII/CNA will provide personal care and assistance with activities of daily living in the home and care client support in a manner that meets or exceeds State, Federal and Agency expectations, under the guidance and supervision of the Registered Nurse to ensure quality and safe delivery of services. All services rendered will be done in accordance with the client Plan of Care orders.

    POSITION QUALIFICATIONS:

    • Maintain current listing with the CNA registry and OIG Exclusions
    • Be able to read, write, and follow instructions
    • Must have completed and approved Nurse Aide training program and or approved competency evaluation program
    • Have a positive attitude toward the care of the sick and elderly
      Demonstration of maturity and proficiency on performing the necessary job duties
    • Must possess a valid driver’s license, personal means of transportation, and a safe driving record
    • Follow the Plan of Care

    Physical Requirements

    • Visual/hearing ability sufficient to comprehend written/verbal communications
    • Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing
    • Ability to deal with stress
    • The following are essential job functions that must be safely performed with or without reasonable accommodations without posing a direct threat to other employees, client, or self
    • Provides and or assists with activities of daily living such as grooming; oral hygiene, bath shower; feeding and nourishment; incontinence care; maintaining the personal environment (i.e, clothing linen within the home).
    • Perform and or assist clients with passive range of motion exercises, ambulation
    • Transfers to from bed, floor, wheelchair and shower chairs as needed
    • Positions client in bed and or chair and may apply and/or adjust orthotic bracing appliances when appropriate.
    • Responds to client’s requests and corrects environment hazards in an appropriate and safe manner.
    • Documents reports care provide and client observations including unusual or significant changes in physical, mental or behavioral conditions and family situations or needs to appropriate health care professional
    • Obtains performs vital signs, heights and weights, intake and output measurements, etc
    • Knows and is able to respond to emergency needs such as Heimlich maneuver, CPR and other disaster procedures by agency policies.
    • Attends to work assignments and in-service training. The Nurse Aide is responsible for maintaining 10-hours of in-service each year as governed by COBRA regulations. The Nurse Aide must renew certification as the state dictates.
    • Observes agency policies and procedures regarding attendance, timelines, house rules, teamwork, customer service and other policies/procedures that may by introduced from time to time.
    • Assist with self-administration of medications which are offered by a physician or other persons authorized by state law to prescribe medicine.
    • Perform incidental household services that are essential to the client’s care at home, dust, mop, sweep, vacuum, make beds, change linen, or do laundry.

    ACKNOWLEDGEMENT:

    I have read this job description and fully understand the requirements set forth therein. I hereby accept the position of In Home Aide. I agree to abide by the requirements set forth and will perform all duties and responsibilities to the best of my ability.

    I further understand that my employment is at-will, and thereby understand that my employment may be terminated at will by the Agency and that such termination can be made with or without notice.

    Note: Must also complete the Criminal Background check and not be listed on the SC CNA Registry or the OIG Exclusions list with a substantiated finding.

  • Powered by Jotform SignClear
  •  - -
  • Applicant Information

  • Emergency Contact

  • Please upload your Social Security Card Below

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Please upload Driver's License Below

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Employment History

  • Please list your current of most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent.

  • Applicant Education and Training

  • References

    Please list any two non-relatives who would be willing to provide a reference fo you:
  • Heaven Sent Helpers

    Statement of Confidentiality
  •  

    I hereby acknowledge that I am employed/contracted to provide services to Heaven Sent Helpers, LLC and that I have been assigned to a patient in need of personal care assistance.

    In consideration of providing personal care assistance, you may be given permission to access personal information for the assigned client. I agree to keep all such information strictly confidential. I agree that I will not disclose such information to any third party and agree not to tell any person about what I see or hear on the premises. I also agree not to take photos of what I see during my visits. I understand Heaven Sent Helpers is obligated to take a notion against me in the event I violate the terms of the statement of confidentiality. 

    This statement of confidentiality also covers visits to any other clients. 

  • Powered by Jotform SignClear
  •  - -
  • Heaven Sent Helpers

    Background Release and Authorization
  • 1. In connection with my application for employment, I understand that a consumer report or investigative consumer report may by requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by Heaven Sent Helpers policy and consistent with the job described, you may by requesting information from public, and private sources about my workers compensation injuries, driving record, court record, education, credentials, credit and references. I am also willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. 

    2. Medical and workers compensation information will only be requested in compliance with the federal Americans with disabilities act ADA and/ or any other applicable state laws. According to the fair Credit Reporting, I am entitled to know if employment is denied because of information obtained by my prospective employers from a consumer reporting agency. I so, I will be notified and given the name and address of the agency or the source which provided the information. 

    3. I acknowledge that a fax or photo copy shall be as valid as the original. The release is valid for most federal, state, and county agencies including the South Carolina department of labor.

    4. I hereby authorize, without reservation, any law enforcement agency, institution, information, service bureau, school, employer, reference, or insurance company contacted by Heaven Sent Helpers or its agent, to furnish the information described in section 1. 

  • Powered by Jotform SignClear
  •  - -
  • Heaven Sent Helpers

    Personal Grooming & Cellular Device Policy
  • Personal Electronic Devices

    Cellular phones and other digital assistants may not be used for personal use in front of guests or clients during work hours. These items must be concealed from view and operated in silent mode if carried.

  • Personal Appearance and Grooming

    Heaven Sent Helpers requires all employees and contractors to present themselves in a professional manner with regard to attire, personal hygiene and appearance. At the minimum, we request all caregivers and staff to:

    * Wear scrubs (clean, in good condition, and fit appropriately)

    * Maintain personal cleanliness (including clean and trimmed fingernails)

    * Not to use heavily scented perfumes, colognes, and lotions (these can cause allergic reactions, migraines and respiratory difficulty)

  • Powered by Jotform SignClear
  •  - -
  • Heaven Sent Helpers

    Alcohol and Substance Abuse Policy
  • Heaven Sent Helpers is a drug and alcohol free workplace. The use of or being under the influence of illegal drugs and /or alcohol is inconsistent with the behavior expected of employees and contractors. The use of illegal drugs and alcohol and the misuse of prescription and over the counter drugs subjects employees and visitors to unacceptable safety risks that undermine the companies ability to operate safely, effectively, and efficiently.

    The use, possession, distribution or sale of controlled substances such as drugs, alcohol, being under the influence of such controlled substances (drugs and alcohol) or testing positive for alcohol or any drugs including but not limited to, inactive components or metabolites associated with the use of such drugs is strictly prohibited while on duty, while on company premises or work sites or while operating the company equipment or vehicles. 

    Heaven Sent Helpers, LLC based on a series of events and circumstances has the discretion to randomly or purposely send workers for drug testing for behavior or abnormal activities. In which we also sporadically choose screen workers at will. One staff member will be selected at random monthly until all employees have been selected in turn. 

    Our company participates in post offer, random and post accident drug and alcohol testing. If injured on the job, you may be expected to participate in a drug and alcohol test immediately following the injury.

  • Powered by Jotform SignClear
  •  - -
  • Heaven Sent Helpers

    COVID - 19 Disclosure, Acknowledgement & Waiver
  • COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread from person-to-person contact. Federal, state, and local governments and health agencies recommend social distancing and have, in many areas, prohibited group activities.

    Heaven Sent Helpers, LLC is taking steps to reduce the spread of COVID-19; however, Heaven Sent Helpers, LLC cannot guarantee that you will not become infected with COVID-19. Further, providing in home care services could increase the risk of contracting COVID-19.

    By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by accepting in home care assignments from Heaven Sent Helpers, LLC and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the act, omission, or negligence of myself and others, including, but not limited to, Heaven Sent Helper staff and their clients.

    I voluntarily agree to assume the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may incur by reason of Heaven Sent Helpers, LLC activity (“Claims”). On my behalf, and on behalf, I hereby release and covenant not to sue Heaven Sent Helpers, LLC, its contracted organizations, employees, volunteers, agents, and representatives, of and from the Claims.

  • Duty to Inform (Please Initial)

    I will inform you if I knowingly come in contact with someone who tested positive within 14 days prior.

  • I will inform you and not provide in-home care services for 14 days if I develop any of the above symptoms.

  • If I test positive for COVID-19, I will not return to provide in-home care services without medical clearance.

  • Heaven Sent Helpers

    Caregiver Health Assessment
  • Family Health History

  • Personal Health History

  • If you selected any items from above, please explain:

  • If answer to any of the above is yes, please explain:

  • Please list any medication allergies:
    Please list any medications that you are curently taking:

  • This information I provided is true and correct to the best of my knowledge.

  • Powered by Jotform SignClear
  •  - -
  • Below to be completed by Heaven Sent Helpers office personnel:

    Comments:_____________________________________________________________________________________________________________________________________________________________________________

     

    Nurse Supervisor Signature______________________    Date:______________

     

     

  • Fee Notice

  • To remain in compliance, Heaven Sent Helpers requires all employees and contractors to have an initial and annual state background check, drug test, and a PPD test if applicable for certain assignments. Upon acceptance of an assignment with Heaven Sent Helpers, the following costs may be deducted from your upcoming payments:

    $25 SLED background check fee

    $30 Drug test fee

    $25 PPD test fee (mandatory for certain assignments)

     

    Please let us know if you have recently had a SLED or PPD test conducted and have a paper copy of the results to avoid the above deductions. The above deductions are allowed to be spread out over several pay periods if requested. 

  •  - -
  • Powered by Jotform SignClear
  • Application Certification

  • I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. 

     

    I authorize Heaven Sent Helpers to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. 

     

    I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS. 

  • Powered by Jotform SignClear
  •  - -
  • Should be Empty: