Please print clearly. This application must be completed and all questions regarding your training and work experience answered. All information on this application is confidential, EFFECTIVE HOME CARE, LLC will not contact your present employer without your consent.

Upload the following documents:

1. Social Security Card
2. Valid passport or Green Card (work authorization)
3. Certificate of Naturalization with ID card
4. Two reference letters
5. Complete physical examination with all lab reports
6. Direct deposit form

Employment Application (Page 2)

The information listed in my application is complete and true. I understand that if employed, false statements on this application are cause for dismissal. I will comply with all of the agency's rules and regulations regarding my employment, EFFECTIVE HOME CARE, LLC may request Information regarding my background which will include work and personal references.

EEFECTIVE HOME CARE, LLC does not discriminate because of sex, age, physical handicap, race, creed or national origin. The agency is an equal opportunity employer.

OFFICE USE ONLY

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B
BROOKLYN, N.Y. 11235
TEL: 718006-1666
FAX: 718-806-1506

RELEASE: I hereby give permission for the above-named agency to verify my document orally.

Orally verified with:

Release of Information: I hereby release from all liability the company, institution or person named above and authorize them to release all information regarding my employment with them.

The person identified above has applied for a position at EFFECTIVE HOME CARE LLC, would you kindly complete the reference information below and return the reference information. This information will be kept confidential. Thank you.

EFFECTIVE HOME CARE LLC

REFERENCE REQUEST

Release of Information: I hereby release from all liability the company, institution or person named above and authorize them to release all information regarding my employment with them.

The person identified above has applied for a position at EFFECTIVE HOME CARE LLC, would you kindly complete the reference information below and return the reference information. This information will be kept confidential. Thank you.

Release of Information: I hereby release from all liability the company, institution or person named above and authorize them to release all information regarding my employment with them.

The person identified above has applied for a position at EFFECTIVE HOME CARE LLC, would you kindly complete the reference information below and return the reference information. This information will be kept confidential. Thank you.

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE. #2B. BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

Work available days and hours for Split shift (12 hours shift Day time or Night time)

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

Print Employee Name

Welcome to EFFECTIVE HOME CARE, LLC.

Regular payday is every Friday.

Please note as of September 25, 2009, the New York Department of Health has made it mandatory for all Home Health Aide and Personal Care Aide training program. Certified Agencies and Licensed Home Care Agencies such as ours to enter in its Home Care Registry all information pertaining to the receipt of your certificate prior to your employment history and date of hire.

If you completed your training after September 25, 2009 the school that you attended will enter your information and EFFECTIVE HOME CARE, LLC's authorized Human Resources personnel will verify your certificate via the Registry.

Once your information has been entered into the New York State Department of Health Home Care Registry it will be viewable by interested parties such as the Department of Health, Federal and State Agencies, Home Care agencies and if necessary by your clients and/or their primary caregivers. The New York State Department of Health has created the Home Care Registry to ensure that our clients will continue to receive safe and compassionate care from the best person possible, EFFECTIVE HOME CARE, LLC is licensed by the New York Department of Health therefor it is our obligation to carry out the Rules and Regulations.

We are excited to have you join our team and look forward to working with you.

Sincerely,

HR Supervisor

By signing this letter, I acknowledge I have been advised of my rate of pay, overtime, Regular pay day and the Home Care Registry. I understand that any information obtained in the use of this authorization may be used to evaluate my suitability for employment and/or continued employment.

POSITION: Home Health Aide

REPORTS TO: Nurse

A Home Health Aide is an individual who provides personal care, home management and other related home health supportive services in order to assist the individual to continue living in their home environment when there are disruptions due to Illness, disability, social disadvantage or other problems in the home. The Home Health Aide is under the direct supervision of the licensed nurse. The HHA provides care in accordance with the DOH Matrix: Permissible and Non-Permissible Activities: HHA Services.

Successful completion of a New York State Department of Health approved Home Health Aide training program as demonstrated by a valid Home Health Aide Certificate.

• Ability to speak, read and write in English sufficiently to understand and interpret the HHA Plan of Care, document care provided on the HHA Time and Activity report and able to call agency to report change and/or issues related to the patient and/or 911 In case of an emergency.
• Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume and distance.
• Holds a valid Home Health Alde Certificate.
• Ability to apply common sense understanding to carry out simple one or two step Instructions. Ability to deal with standardized situations with only occasional or no variables.

MOST FREQUENT CONTACT: Patients/ Patients families; Agency staff (coordinator, nurse)

NATURE OR PURPOSE: Provide care and service receive supervision, development of POC

EQUIPMENT OPERATION: Walker, Cane, Crutches, Wheelchair, Commode, Hospital Bed, Hoyer Lift, Household appliances (i.e. vacuum, refrigerator, stove, blender, toaster, etc.)

POSITION: Home Health Aide

REPORTS TO: Nurse

POSITION SUMMARY: A Home Health Aide is an individual who provides personal care, home management and other related home health supportive services in order to assist the individual to continue living in their home environment when there are disruptions due to Illness, disability, social disadvantage or other problems in the home. The Home Health Aide is under the direct supervision of the licensed nurse. The HHA provides care in accordance with the DOH Matrix: Permissible and Non-Permissible Activities: HHA Services.

Successful completion of a New York State Department of Health approved Home Health Aide training program as demonstrated by a valid Home Health Aide Certificate.

• Ability to speak, read and write in English sufficiently to understand and interpret the HHA Plan of Care, document care provided on the HHA Time and Activity report and able to call agency to report change and/or issues related to the patient and/or 911 In case of an emergency.
• Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume and distance.
• Holds a valid Home Health Aide Certificate.
• Ability to apply common sense understanding to carry out simple one or two step Instructions. Ability to deal with standardized situations with only occasional or no variables.

MOST FREQUENT CONTACT: Patients/ Patients families; Agency staff (coordinator, nurse)

NATURE OR PURPOSE: Provide care and service receive supervision, development of POC

EQUIPMENT OPERATION: Walker, Cane, Crutches, Wheelchair, Commode, Hospital Bed, Hoyer Lift, Household appliances (i.e. vacuum, refrigerator, stove, blender, toaster, etc.)

SPECIFIC DUTIES AND RESPONSADILITIES: In order to comply with the Americans with Disabilities Act (ADA), each essential duty would be indicated with an "X" in the ADA box. A duty is essential if: (1) the position exists to perform that duty; (2) it requires) specialized skills and/or expertise; (3) it can only be performed by a limited number of available employees.

1. Foley catheter irrigation.
2. Apply a sterile dressing.
3. Give enemas or remove impactions.
4. Perform gastric lavage or gavage.
5. Applications of heat in any form.

1. Assists other employees where needed.
2. Is responsible and cooperative with patients/families, supervisors, fellow employees.
3. Maintains friendly working atmosphere.
4. Maintains appropriate attitude.
5. Maintains appropriate appearance.
6. Accepts constructive criticism as evidenced by appropriate changes in behavior.
7. Utilizes established channels of communication.
8. Recognizes, accepts and respects people as individuals.
9. Recognizes limitations and seeks assistance appropriately.

1. Ability to apply prosthetic devices.
2. Ability to take and record TPR and measure I&O.
3. Ability to reinforce sterile dressing and change non-sterile dressing,
4. Ability to follow the instructions related to exercise and positioning.
5. Ability to safely use the Hoyer lift.
6. Ability to- care for urinary, ostomy and Foley catheters.
7. Ability to apply warm or cold compress, ace bandage and elastic stockings.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Check one physical requirement which applies to this position:

MEDIUM WORK: Exerting up to 50 pounds of force occasionally and/or up to 20 pounds of force frequently and/or up to 10 pounds of force constantly to move objects.

WORK ENVIROMENT: Patient's home.

CONFIDENTIALITY STATEMENT: Agency records are maintained in a safe and secure area with specific access availability to ensure confidentiality. Agency records, files, documents and reports are the exclusive.

Bill de Blasio
Mayor

Consumer
Affairs
Lorelei Salas
Commissioner

Under New York City's Earned Safe and Sick Time Act (Paid Safe and Sick Leave Law), certain employees have a right to safe and sick leave. Go to nyc.gov/PaidSickLeave to learn which employees are covered by the law.

Employees who work for employers with five or more employees who work more than 80 hours a calendar year in New York City have a right to paid safe end sick leave. Employees who work for employers with fewer than five employees have a right to unpaid safe and sick leave.

Employees who work for employers who must provide safe and sick leave must receive this written notice from their employer when they begin employment or by June 4, 2018, whichever is later.

YOU HAVE A RIGHT TO SAFE LEAVE, which you can use to seek assistance or take other safety measures if you or a family member may be the victim of any act or threat of domestic violence or unwanted sexual contact, stalking, or human trafficking.

YOU HAVE A RIGHT TO SICK LEAVE, which you can use for the care and treatment of yourself or a family member.

• Your employer must provide up to a total of 40 hours of safe and sick leave every calendar year.

• You accrue safe and sick leave at the rate of one hour for every 30 hours worked, up to a maximum of 40 hours of safe and sick leave per calendar year.

• You begin to accrue safe and sick leave on April 1, 2014 or on your first day of employment, whichever is later.

Exception: If you are covered by a collective bargaining agreement that was in effect on April 1, 2014 f you begin to accrue safe and sick leave under City law beginning on the date that the agreement expires.

• You could begin using sick leave on July 30, 2014 or 120 days after you begin employment whichever is later.
• You could begin using safe leave on May 5, 2018 or 120 days after you begin employment, whichever is later.

You can use safe and sick leave to take time off from work when:

• You have a mental or physical illness, injury, or health condition; you need to get a medical diagnosis, care, or treatment of your mental or physical illness, injury, or condition; you need to get preventive medical care.
• You must care for a family member who needs medical diagnosis, care or treatment of a mental of physical illness, injury, or health condition, or who needs preventive medical care.

POLICY AND PROCEDURE MANUAL

1. Foley catheter irrigation.
2. Apply a sterile dressing.
3. Give enemas or remove impactions.
4. Perform gastric lavage gavage.
5. Applications of heat in any form.

1. Assists other employees where needed;
2. Is responsible and cooperative with patients/families, supervisors, fellow employees;
3. Maintains friendly working atmosphere;
4. Maintains appropriate attitude;
5. Maintains appropriate appearance;
6. Accepts constructive criticism as evidenced by appropriate changes in behavior.
7. Utilizes established channels of communication.
8. Recognizes, accepts and respects people as individuals;
9. Recognizes limitations and seeks assistance appropriately.

15

1. Knowledge of safe and appropriate method of providing personal care.
2. Knowledge of meal preparation and basic nutrition.
3. Knowledge of environmental management and safety.

Patient's home, facilities

Agency records are maintained in a safe and secure area with specific access availability to ensure confidentiality. Agency records, files, documents and reports are the exclusive property of the Agency. Only authorized personnel will have access to clinical/financial/personnel records.

All agency records, files, documents and Access to confidential employee/patient information files will be limited to agency personnel involved in the care and service of the patient.

Agency staff with access to computer files holds all information in strictest confidence in the processing, storage and discarding of all data. Only authorized personnel will have access to written and computer data information; Authorized personnel will be assigned passwords/access codes to computer files necessary to conduct their responsibilities;

Responsibilities of this job position has clearance for access to the following confidential information:

Patient plans of care, identifying patient data.

I have been oriented to the agency's confidentiality policy. I understand that any Agency employees who do not honor the Confidentiality Policy are subject to termination and possible legal action. I agree to abide by the agency's confidentiality policy.

Job description reviewed and understood.

Personal Care Aide -3

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

Effective home care is notifying you about New York City's earned safe and sick time act (paid safe and sick leave law).

Please read and acknowledge the receipt of this notice by signing this letter below and mail it in self-stamped envelope provided for your convenience.

Effective Home Care le esta notificando acerca de las ganacias de tiempo de cuídado y enfermedad de la ciudad de Nueva York (Paid Safe and Sick Leave Law).

Por favor leer y verificar la recivida de esta carta, firme de bajo. Envie por correo en el sobre stampado.

مؤثر گھر کی دیکھ بھال آپ کو نیویارک سٹی کے کمائے گئے محفوظ اور بیمار وقت کے ایکٹ معاوضہ محفوظ اور بیماری کی چھٹی کے قانون کے بارے میں مطلع کر رہی ہے۔

براہ کرم ذیل میں اس خط پر دستخط کرکے اس نوٹس کی وصولی کو پڑھیں اور اسے اپنی سہولت کے لیے فراہم کردہ خود مہر والے لفافے میں بھیجیں۔

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

As an employee of EFFECTIVE HOME CARE LLC, I acknowledge receipt of the Agency issued photo identification card. As required by regulation and agency policy, I agree to wear the ID when working.

Identification card is the property of EFFECTIVE HOME CARE, LLC and shall be returned to the agency upon termination of employment.

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

Employees must avoid any interest, influence. Or relationship which might conflict or appear to conflict with the best interest of EFFECTIVE HOME CARE, LLC. You must avoid any situation in which your loyalty may be divided and promptly disclose any situation where an actual or potential conflict may exist.

• I Having a financial interest in any business translation with EFFECTIVE HOME CARE, LLC.
• Owning or having a significant financial interest in, or other relationship with EFFECTIVE HOME CARE, LLC. Competitor, costumer or supplier.
• Accepting gifts, entertainment or other benefit of more than a normal value from EFFECTIVE HOME CARE, LLC. Competitor, costumer or supplier.

Anyone with a conflict of interest must disclose it to management and remove themselves from negotiations, deliberations or votes involving the conflict. You may, however, state your position and answer questions when your knowledge may be of assistance to EFFECTIVE HOME CARE, LLC.

EFFECTIVE HOME CARE, LLC

110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235

TEL: 718-806-1666 / FAX: 718-806-1506

To File: 05-18-2016

From: Human Resources Dept

Ref: Leave of absence Policy

Effective Home Care LLC has adapted Leave of Absence Policy effective immediate. This policy is based on NYS applicable Labor Law and NYS DOH regulations. As a reminder, employees are provided with one-week paid vacation per year. Any period more than one week, but not more than 90 days, will be considered Leave of Absence without pay. In this case employee must notify management of his/her plans at least 21 days in advance, unless it is an emergency situation (e.g. death in the family).

If employee decides to take 90 days and more off, he/she will be subject to rehiring process and his/her tenure with the company will. be nullified and will start from date of hire.

Acknowledgement:

20

Signing this letter certifies that I have read and understand that Relatives MAY NOT BE
the Personal Care Aide: Spouse, Parent, Son, Son-in-law, Daughter or Daughter-in-law.
According to the 18 NYCRR § 505.14 (h)(2)
(2) Payment for personal care services shall not be made to a patient's spouse, parent, son,
son-in-law, daughter or daughter-in-law, but may be made to another relative if that other
relative:
(i) is not residing in the patient's home

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

HHRS AND PCA'S assigned for live in

case

Aides who assigned for live-in cases (live on premises of the patient), have to follow rules implemented by Effective Home Care LLC under New York State Labor Law.

Aides are providing care for patients on live- in case according to plan .of care. They work and are receiving compensation for 13 hours of work.

Aides are getting 8 hours to sleep. However, Aides must sleep continuously for 5 (five) hours. If patient condition deteriorates to the point where aide will need to interrupt his/her sleep, then aide must report this situation to the agency next morning, so appropriate measures can be taken to the correct problem.

Reporting must be provided by FAX or E-mail or by Texting for records keeping.

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B. BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

To: All newly hired employees

Re: 90 days probation period

As per Company Policy all newly hired employees will undergo 90 calendar days of probation period.
During this period (90 days or earlier) the Company reserves the right to terminate the employee at Company's own discretion.

I have read and agree:

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

02/12/2018

To All field employees:

Please be advised that those employees who did not elect to receive their payroll checks through direct deposit to their bank account are personally responsible for lost or undelivered payroll check sent by mail.

Please kindly sign below that you read and understood the content of this letter

EFFECTIVE HOME CARE, LLC
110 NEPTUNE AVENUE, #2B, BROOKLYN N.Y. 11235
TEL: 718-806-1666 / FAX: 718-806-1506

I _________________________ was trained by the
Agency Effective Home Care, LLC about Sexual Harassment Prevention Policy.
I was informed about my rights and the way to report any evidence to the Agency.