A Caring Connection R.N. / L.P.N. Onboarding Application
  • A Caring Connection Onboarding Application

    Please complete all of the required fields for onboarding
  • IMPORTANT: If a field does not apply to you, please fill it in with the term N/A for not applicable. If you have any questions while filling out this form you can contact your recruiter via email at hiring@acccares.net or phone 908-232-6484. Please hit save on the bottom of each page to ensure information has been saved.

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  • Are you a citizen of the United States?*
  • Gender

  • Have you previously worked for A Caring Connection?*
  • Were you referred by a current employee of A Caring Connection
  • Licensing

  • Position applying for*

  • RN, LPN or CHHA license/certificate information:
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  • Emergency contacts

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  • Education

    Please list all education and training; including vocational schools and trainings attended
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  • Work experience: Please list all employer's within the one year preceding the date of this application

  • Employer Name:   * Employer Address:   *  
    Supervisor Name: *Supervisor Phone Number:   *   
    Position Title:*   Dates of Employment:  Pick a Date*   to*        
    Reason for leaving:   *   

  • Employer Name:   * Employer Address:   *  
    Supervisor Name: *Supervisor Phone Number:   *   
    Position Title:*   Dates of Employment:  Pick a Date*   to*    
    Reason for leaving:   *   

  • Patient experience*
  • Locations of clinical experience*

  • Skills*

  • Personal references

    Ex: former employer, minister, teacher, or someone with good standing in the community.
  • It is required to have at least two references complete the reference request for recording purposes. One reference must be a supervisor. You can, copy and send this link to any of your references.
    ACC Employee Reference Request - https://hipaa.jotform.com/220775663045155

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  • In what capacity does your reference know you?*

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  • In what capacity does your reference know you?*

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  • I hereby authorize A Caring Connection to request and receive from all prior employers within one year of the date of this application, and all pertinent information concerning my prior employment and its termination, including the reasons for such termination.*
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  • What age group will you work with?
  • Criminal background check

    You will not be denied employment based solely on your following answers
  • I authorize A Caring Connection to run a background check with all state and federal agencies*
  • Have you ever had your nursing license revoked or suspended?*
  • Have you ever been convicted of, pled guilty to or pled nolo contendere to any felony in the last ten years or been found liable or responsible for or named as a defendant in any civil offense that is reasonably related to your qualifications, competence, functions or duties as a medical professional?*
  • Have you ever been convicted of, pled guilty to or pled nolo contendere to any felony in the last ten years or been found liable or responsible for or named as a defendant in any civil offense that is alleged fraud, an act of violence, child abuse or sexual offense or sexual misconduct?*
  • Have you ever been indicted in any criminal suit?*
  • Have you ever been court martialed for actions related to your duties as a medical professional?*
  • Are you currently engaged in the illegal use of drugs? (“Currently” means sufficiently recent to justify a reasonable belief that the use of drugs may have an ongoing impact on one’s ability to practice medicine. It is not limited to the day of, or within a matter of days or weeks before the date of an application, rather that it has occurred recently enough to indicate the individual is actively engaged in such conduct. “Illegal use of drugs” refers to the drugs whose possession or distribution is unlawful under the Controlled Substances Act, 21 U.S.C. § 812.2. It does not include the use of a drug taken under supervision of a licensed health care professional, or other uses authorized by the Controlled Substances Act or other pro vision of federal law.” The term does include, however, the unlawful use of prescription controlled substances.)*
  • Do you use any chemical substances that would in any way impair or limit your ability to perform the functions of your job with reasonable skill and safety?*
  • Do you have any reason to believe that you would pose a risk to the safety or well-being of your clients?*
  • I hereby certify that the information I have provided in the Criminal Background Questionnaire is true, complete, and accurate to the best of my knowledge.*
  • I authorize the A Caring Connection to verify the information I have provided and to obtain additional information as necessary for employment purposes, in compliance with all applicable laws and regulations.*
  • Job descriptions

    The following are three job descriptions that pertain to this employee application. Please sign the job description that you are applying for to help us ensure you are aware of the job responsibilities of this position.
    • Territory Nurse Supervisor 
    • Territory Nurse Supervisor

      The Territory Nurse Supervisor will oversee a team of nurses who provide highly skilled home healthcare services to our patients. The Territory Nurse Supervisor will evaluate the field nurses upon visit to grade their quality of care, attention to detail and recording of visit notes. The Territory Nurse Supervisor duties will also include training and mentoring the nursing staff and consulting on patient care plans.

      Staff management:

      • Management of field staff which includes (RNs, LPNs and Aides).
      • Address staff concerns.
      • Complete performance evaluations for staff.
      • Perform orientations and teaching the staff on trach, ventilator and g-tube patients.
      • Oversee the quality of nurse note submission.

      Client management:

      • Create and/or maintain all patient clinical charts:
        • Care plans
        • Medication documentation
        • 485 physician signatures
      • Visit each nurse and patient every 30 days.

      General duties and responsibilities:

      • Ensure patient short and long term goals are being met.
      • Communicate with staff and department heads.
      • Keep and organize records of the patient list through our online clinical software.
      • Solve any problems patients might have on site.
      • Ensure agency quality assurance.
      • Listening to the concerns of family members and answering their questions.

      Required skills:

      • Current RN license in good standing.
      • Experience in home healthcare or public health nursing preferred.
      • A completed apprenticeship or experience in a similar role.
      • Excellent observational and problem-solving skills.
      • The ability to follow instructions but also to act independently where necessary.
      • Excellent reporting and writing skills.
      • Active listening skills and empathy.
      • Physical and mental strength.
    • Registered Nurse 
    • Licensed Registered Nurse

      Position Scope:
      • To ensures quality and safety delivery of home health services for assigned clients
      • To assist in the provision of home health care services that reflect agency philosophy and standards in the care of assigned clients.
      • To ensure provide adequate qualifications to service those patients that fall under various levels of care, including, but not limited to high-tech nurses.
      • Position Qualifications:
      • Graduate of an accredited School of Practical Nursing required
      • Those LPN's who service high tech cases must have evidence of high tech skills or education, not limited to, but including such experience as vent, pediatric, ER, or acute care.
      • Current licensure as a Practical Nurse with the New Jersey with the New Jersey Board of Nursing required.
      • Experience in home health care preferred
      • Good verbal and written skills required.

      Physical Requirements:
      • 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.

      Performance Responsibilities:
      • To ensure quality and safe of practical nursing services provided to assigned clients
      • Complies with agency policies and procedures
      • Fulfills assignments as scheduled by the agency.
      • Physician orders are accurately implemented
      • Provides practical nursing services to assigned clients that are in accordance with the Individual’s plan of care.
      • Client clinical record documentation is completed in a timely manner and accurately reflects delivery of practical nursing services
      • Accurately reports observations of client condition to the Registered Nurse in a timely manner
      • Communicates information regarding the client to appropriate individuals.

    • Licensed Practical Nurse 
    • Licensed Practical Nurse

      Position Scope:
      • To ensures quality and safety delivery of home health services for assigned clients
      • To assist in the provision of home health care services that reflect agency philosophy and standards in the care of assigned clients.
      • To ensure provide adequate qualifications to service those patients that fall under various levels of care, including, but not limited to high-tech nurses.
      • Position Qualifications:
      • Graduate of an accredited School of Practical Nursing required
      • Those LPN's who service high tech cases must have evidence of high tech skills or education, not limited to, but including such experience as vent, pediatric, ER, or acute care.
      • Current licensure as a Practical Nurse with the New Jersey with the New Jersey Board of Nursing required.
      • Experience in home health care preferred
      • Good verbal and written skills required.

      Physical Requirements:
      • 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.

      Performance Responsibilities:
      • To ensure quality and safe of practical nursing services provided to assigned clients
      • Complies with agency policies and procedures
      • Fulfills assignments as scheduled by the agency.
      • Physician orders are accurately implemented
      • Provides practical nursing services to assigned clients that are in accordance with the Individual’s plan of care.
      • Client clinical record documentation is completed in a timely manner and accurately reflects delivery of practical nursing services
      • Accurately reports observations of client condition to the Registered Nurse in a timely manner
      • Communicates information regarding the client to appropriate individuals.

    • Home Health Aide 
    • Home Health Aide

      Summary
      Responsible for providing care for people confined to their homes due to being disabled, cognitively impaired, or chronically ill. Cares for elderly people who prefer to remain in their home as opposed to health facilities or institutions. Applicants are considered appropriate for hire after the agency is satisfied that the potential employee can treat clients with respect, consideration, individuality and personal property. This can be satisfied by reference checks before start of employment, have provided evidence that they have met the standards of the Board of Nursing, are certified in good standing and have passed their application requirements.

      Primary responsibilities:
      • Provide healthcare in someone's residence.
      • Assist people in hospices and day programs.
      • Go to same home or homes every day or months or even years.
      • Work under direct supervision of a nurse.
      • Keep records of services performed.
      • Record and note clients' condition and progress.
      • Report changes to case manager.
      • Check patient's pulse rate, temperature, and respiration rate.
      • Perform prescribed exercises and other physical therapy.
      • Remind patient to take medications.
      • Change dressings.
      • Turn or ambulate patient.
      • Provide skin care.
      • Massage limbs.
      • Assist with braces and artificial limbs.
      • Assist with medical equipment.
      • Ensure equipment is functioning properly.
      • Replace batteries on equipment.
      • Prepare food and feed patient.
      • Provide counseling on diet and exercise.
      • Implement behavior plans.
      • Teach self-care skills.
      • Perform light housekeeping.
      • Provide patient with groceries.
      • Pick up medication.
      • Transport patient to doctors' office or hospital.
      • Signs and dates documents such as necessary per policy manual standards, Best Practices, accrediting agencies and federal/state regulations

      Organizational Relationship:
      The position of Home Health Care Certified Home Health Aide reports to the Director of Nursing

  • Credentials Upload

    If you need assistance with uploads please reach out to your recruiter.
  • Do you have malpractice insurance? ACC strongly suggests that all professional nurses carry their own insurance. You may call or go on line, NSO Nurses Service Organization to obtain/purchase your malpractice insurance.*
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  • Malpractice Insurance Name:* Address: *Policy Number:  *   

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  • Feel free to use the Cleared To Work Physical Form attached here. You may also use your own physical form but it must contain a cleared to work section.

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  • Did you receive the Hepatitis B Vaccine (3 rounds)?*
  • Did you decline the Hepatitis B Vaccine?*
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  • I attest with my signature below that I have provided to accurate and complete information
    on this application. If any information I have provided is false, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. I authorize with signature below; A Caring Connection to run a background check and to request prior work experience from previous employers. 

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