NEWDAWN CARE LLC

NEWDAWN CARE LLC
Name (Last, First, Middle)
Address (Street, city, state Zip code)
Phone Number
Email Address
example@example.com
Date Of Birth

MonthDayYear
Date
Social Security Number
Position applying for
How did you hear about the company

FriendCurrent employeeOnline"other"
Are you interested in

Part timeFull time
Have you ever worked with individuals with developmental disabilities?

YesNo
Have you completed any DOS required training?

YesNo
Select any of the below training in which you are currently certified. (You must provide certificate)

FoundationsPA1PA1ConnectionsNuts & BoltsEthical/LegalcommunicationsIP TrainingSkill BuildingHealth Day 1Health Day 2Mealtime ChallengesMATETL 1ETL 2CPRFirst Aid

What Days and times are you available to work?

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Mornings
Afternoons
Evenings
Over Nights

Can you at least work one weekend shift

YesNo

Previous Employment

Please list the last 10 years of your employment history, starting with the most recent employer:
Company Name
Address
Phone
Dates of Employment

MonthDayYear
Date
Title and Job Duties
Reason for Leaving
Name of supervisor
May we contact your employer?

YesNo
EMPLOYEMENT EXPERIENCE
Company Name & Address
Phone Number
Supervisors Name
Name
Phone Number

NEWDAWN CARE LLC primary purpose is to assist persons with development disabilities reach their highest potential in everyday settings. Part of the training and job requirement is to work with this population. This does require each employee to be able to bend at the waist, kneel, stoop and lift 50lbs. Employees must be able to perform the job requirements that come with a HTS (Habilitation Training Specialist Including but nit limited to transportation to and from work, school, meeting, etc.
If offered the position, can you perform these essential job requirements?

YesNo
Are you a citizen of United States or, if not, are you legally authorized to work in United States? if offered employment, you will be required to submit identification in accordance with INS rules and regulations

YesNo
Yes

CERTIFICATION, AUTORIZATION AND RELEASE: I certify that all information on this application is accurate, complete and true to the best of my knowledge. I understand that any information that is found to be false, inaccurate, incomplete or misrepresented in any respect will be sufficient cause to (I) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service when it is discovered.

I expressly authorize, without reservation, NEWDAWN CARE LLC, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and education institutions and to otherwise verify the accuracy of all information provided by me in this application, resume' or job interview. I hereby waive all rights and claims I may have regarded NEWDAWN CARE LLC, its agents, employees or representatives for seeking, gathering and such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that NEWDAWN CARE LLC does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for, employment on a basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 90 days. At the conclusion of that time, if have not heard from NEWDAWN CARE LLC and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and NEWDAWN CARE LLC reserves that same right to terminate my employment at any time, with or without cause and without prior notice, expects as may be required by law. This application does not constitute an agreement or contract for unemployment for any specified period or definite duration. I understand that no supervisor or representative of NEWDAWN CARE LLC is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are writing and signed by the Executive Director.
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JOB DESCRIPTION AGREEMENT
By the requirements and performance expectation(s) in the job description. Moderate exposure to hazardous risks, including potential for exposure infections and communicable diseases, blood and body fluids, electrical equipment, chemicals, such as alcohol and Clorox, must follow universal safety precautions. Contact with adults who may exhibit physical, behavioral outbursts related to a mental health condition.

I have read the job description for the position of, and I am able to perform the duties of the position.

I agree to abide
SECURITY
Adheres to agency's policies and procedures including HIPAA, privacy, confidentiality, and Conflict of interest.
SUPERVISION RECEIVED
The H.T.S is hired by HR and supervised by the HM, PC, and SR PC. My supervisor and I have discussed the details of my job description, and I fully understand my job responsibilities. I also understand the need to be flexible with change, that there may be additions or deletions to my present job description. If I have any additional questions or concerns, it is my responsibility to bring it to the attention of my supervisor,
Employees signature

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Human resources
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NEWDAWNCARE LLC
IMPORTANT INFORMATION FOR ALL HTS

NEWDAWN CARE LLC is contracted with the state of Oklahoma under the Department of Developmental Disabilities. The agency gives out application to new staff, run a background check and only hires and retains works if the clients and family members choose to work with them. In cases where some clients or family members do not approve of their staff, they have the right to refuse them entrance into their homes, terminate the contract they with the agency and move to another agency. Due to the limited control over staff hiring and termination the agency is not responsible for unemployment to that work in client's homes.

1. UNDER NO CIRCUMSTANCES WILL an HTS have anything to consumer finance.

2. HTS CAN NOT give or receive money from consumers.

3. HTS WILL NOT under, and circumstance GIVE MEDICATION UNLESS they have MAT or CMA certified

4. In case if an emergency, the HTS should contact office immediately of their immediate supervisor

5. In case of an incident, HTS will be required to complete an INCIDENT REPORT immediately. The report needs to reach the office no later 24-hours after the incident

6. HTS CANNOT exceed the number of HTS HOURS or MILEAGE allocated for the consumer per week

7. ALL TIME SHEETS must be signed by family member or guardians be valid

8. HTS must continue working for the company at LEAST 90 DAYS AFTER completing training.

9. HTS CAN not accept gifts or presents from consumers.

I have read, understand and accept these conditions and terms:
Employees Signature

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RELEASE OF INFORMATION
I, hereby authorize my prior employer to release all information related to my employment to NEWDAWN CARE LLC.

I agree that no persons, companies, or organizations shall be liable for any information communicated to NEWDAWNCARE LLC in connection with the hiring process.

I understand that any information released by my prior employer will be held in the strictest confidence, that I will be viewed by those involved in the hiring process and that neither / nor anyone else not so involved will have the right to see the information

I have read, understand, and accept these conditions and terms.
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CONDITIONAL OFFER EMPLOYMENT
This agreement is to consider you for employment with the understanding that it is conditional pending reference checks, background checks, community service registry checks, and all future interview requirements with our consumers, consumer parents, or NEWDAWN CARE LLC supervisor.

By signing this agreement, you understand and agree to these conditions. In the event, that NEWDAWN CARE LLC finds any complications in the above names investigation procedures after offering you employment with NEWDAWN CARE LLC, you understand you are subject to immediate termination

I have read, understand and accept these conditions and terms
Date

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Date
administrative Representative
Date

MonthDayYear
Date
Should be Empty:

NEWDAWN CARE LLC

EMPLOYEMENT EXPERIENCE

JOB DESCRIPTION AGREEMENT

SECURITY

SUPERVISION RECEIVED

NEWDAWNCARE LLC

RELEASE OF INFORMATION

CONDITIONAL OFFER EMPLOYMENT