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  • Employment Application

    We appreciate your interest in Shining Star Home Health Care. We are an equal employment opportunity employer. The company's policy is not to discriminate against any applicant or employee based on race, color, sex, religion, national origin, age, disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. This application form is intended or use in evaluating your qualifications for employment with us: Please answer all appropriate questions completely and accurately.
  • Date of Application*
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  • Which county are you available to work in?
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  • Are you authorized to work in the United States?*
  • Have you worked for this company before?*
  • Were you referred by an employee?*
  • Rows

  • Current Employment:

  • Are you currently employed?*
  • If yes, can we contact your employer?*

  • Background and Employment History

  • Certificate, Diploma, Degree?
  • Certificate, Diploma, Degree?
  • Certificate, Diploma, Degree?
  • Start Date
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  • End Date
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  • Start Date
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  • End Date
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  • Professional References:

    Please your three (3) professional references who are not related to you.

  • Applicant's Statement and Acknowledgement

  • *   I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered.

    *   I recognize that this employment application is not an odder of employment. I agree that if I am hired by the company, I will be an at-will employee, meaning that either the company or I may end the employment relationship at any time with or without cause of notice.

    *   I further understand and agree that, except for my at-will employment status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s), will be subject to change by Shining Star HHC.

    *   I understand that the company may share eh information contained in this application with other company employee for employment and administrative purpose and hereby consent to such transfer.

    *   I hereby authorize, to the extent allowed by applicable federal state and local laws, Shining Star HHC to conduct its own investigation of my references, employment history and education and, further, authorize the references and prior employers I have listed to disclose to the company information related to my employment history and qualifications for the position for while i am applying, without giving me prior notice of such disclosure.

  • By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.  

    In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.  

    I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.  

  • Caregiver Competency Assessment Test

  • 1. Communication is best defined as*
  • 2. Ms. Jones accuses you of stealing twenty dollars. You did not take the money, but Ms. Jones does not believe you. What should you do?*
  • 3. Which is an example of confidential client information?*
  • 4. The guidelines for documentation of care in the home include which of the following?*
  • 5. A Home Health Aide/CNA's responsibility is to:*
  • 6. A Home Health Aide/CNA is behind schedule in seeing all of the assigned clients, so she decides to skip part of the care for her last client, but she documented that a visit was completed as assigned. This is an example of:*
  • 7 Cleaning the bathroom includes cleaning the following:*
  • 8. Cleaning the floors includes the following*
  • 9. To change the linens on a bed, the Home Health Aide/CNA should*
  • 10. Mr. Smith is a client with dementia and he is coming very agitated. Which of the suggestions listed below would be helpful in dealing with Mr. Smith's behavior?*
  • 11. Which of the duties listed below would a Home Health Aide/CNA do to promote a safe home environment for the client?*
  • 12. Which product listed below is a disinfectant?*
  • 13. You can extinguish a grease fire by*
  • 14. What is the BEST procedure to follow when you have a fire in the home?*
  • 15. What is the MOST important number to call in case of a medical emergency*
  • 16. You arrive at a clients home that lives alone. He/ She does not answer the door when you knock and the door is locked. What do you do FIRST?*
  • 17. Which is the best method for removing soiled linen from the clients bed?*
  • 18. The proper procedure for hand washing includes all of the following EXCEPT*
  • 19. Which of the statements describes good body mechanics*
  • 20. When lifting an object which is the best muscle to use?*
  • 21. The Food Guide Pyramid is*
  • 22. When preparing a meal for the client, remember to:*
  • 23. Mr and Mrs. Williams are both in their 70's. They seem to be distressed about changes that are affecting their lives. Which of the following would be stressful?*
  • 24. Which of the statements is true about any client with disabilities?*
  • 25. The Home Health Aide/CNA should:*

  • I attest that i have completed this assessment with no outside assitance.

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  • Should be Empty: