01. Biographical Resume
Are you aware that this is a home and community bases service agency. Sessions are not held in a local office and will either be at client's homes are within the general community.
What services will you being doing? Select as many as you need to. The ones you select will determine what questions you see throughout the form and what further documents/training will be required, so please make sure to read and select carefully. I would like to....
Care for someone who lives in my home
Be a Care Partner providing respite, community connections, mentoring, homemaking, etc. (I DO NOT already know my client)
Drive clients to do outings in the community / organize group or solo activities
Help individuals with medication
Provide hands on care assistance for activities of daily living (bathing, toileting, eating, etc.)
Provide massage therapy (and I have my Colorado license)
Open my home and be a host home provider
Provide short term services inside my home such as mentorship or respite or massage
Access a community location such as an office to provide massage in the community
Be a homemaker, both providing the services and coaching individuals on how to care for their home
Help one of my friend or family members who needs services
Connect my business with Angels Service to partner in providing care to the community
To talk to individuals on the phone when they are lonely or sad or just want to talk (volunteers only)
Provide administration services
I want to do everything I selected as a volunteer
(Answer these questions as through you were sharing the information with a potential client)
This is a little about me...
My philosophy in life is...
Include why you want to work with children and adults with disabilities as part of your philosophy
One of my favorite quotes is...
Quality Provider Information
My personal experiences that make me a qualified provider are...
My professional experiences that make me a qualified provider are...
My educational experiences that make me a qualified provider are...
Business. How long has your business been established?
Business. What is your business's specialty?
Business. How would partnering with your business benefit our community?
FCCG. Live in, Family, and Friend Care Partners
FCCG. Only some of your time as a care partner will be paid. What is paid will be determined by the service plan and job duties. For example. If you life with someone you may be paid 3 hours of the day and the rest of the time would just be your time as a family member / friends or if you have your friend stay with you for the weekend perhaps 16 hours over the course of two days would be paid with the rest of the time being friendship time.
Yes, I understand.
FCCG. Please share your story with us. How do you know the person you want to provide care for.?
FCCG What is a time that you have felt challenged or frustrated as a care partner for your loved one?
FCCG. Are there any areas where you would benefit from extra support or training so that you could provide better care?
Massage Therapy. Scenario 1. You have a child with autism who is consistently moving about their home and experiences ongoing tightness in their legs and presents with an abnormal gait with compromised balance. What would your tentative treatment plan be to serve this child?
Massage Therapy. Scenario 2. You have an older adult who recently experience a mini stroke. They have no contraindications for massage and sessions have been approved by the doctor. You client is experiencing stress due to the impact of the stroke and impaired movement on the right side of their body. They are in a wheelchair and wish to remain their for the duration of their session. What would your tentative treatment plan be to serve this adult?
Massage Therapy. Scenario 3. You are working with a family and the parents want the session to mimic a spa environment, no talking, low lights, massage table, etc. However, the child enjoys talking and wants to keep all their clothes on including their shoes during the session. How would you explain to the parents that massage can be beneficial in different formats. (Hint, do you have to have a massage table in order to provide a quality massage)
Massage Therapy. Scenario 4. You are working with a new individual who is tactically defensive (afraid of touch). How will you introduce touch to them and what might your sessions look like while you support them in gaining the skills of accepting touch?
Massage Therapy. Scenario 5. Describe how you would teach a parent to massage their child between sessions or describe how you would support your client in learning how to participate in self care in between session.
Massage Therapy. Scenario 6. Is it okay for a family member to remain with you during the sessions until they feel comfortable?
CP. Community Connector / Respite Questions
CP / Community Time. Tactics, strategies, and supports that I use when inappropriate behavior is present,
CP / Community Time. Please describe goals you have had success with.
CP / Community Time. My experiences with children and adults with disabilities includes
(identify specific conditions, medical needs, behavioral challenges, how long you have been providing services, etc.)
Documents for Required for Initial Review
Upload your cover letter (optional)
Upload your resume or curriculum vitae (optional)
Have you ever been charged or convicted of any unlawful sexual offense, or mistreatment, exploitation, neglect, or abuse of a person of any age?
I certify that all information provided in any documentation is true and complete. I understand that any false statements or omissions may disqualify me from further connections to Angels Service LLC. I authorize,whether listed or not, any person or agency, e.g. school, employers to information and opinions that may be useful in making a decision in accepting my services to Angels Service LLC and the community. I understand that if I am extended an offer of independent contractor or volunteer or other contract can be revoked or changed at any time with or without notice. Anyone who provides a false statement of any material fact or thing is guilty of perjury in the second degree as defined in section 18-8-503, CRS. I understand that this is a permanent statement and applies to all interactions with the agency.
Yes, I agree
Type in name for electronic signature
Is there anything else that you would like to share?
How much notice do you need in order to provide additional respite, such as if I find out Tuesday that there is a movie I want to go to on Friday with friends... can I ask on short notice?
Reference summary, name of reference, contact information, and relationship.
What agent status are you interested in?
Natural Support Volunteer (I have someone I care about but need help learning how to be part of their life)
Contractor(1099) - I understand that I must be registered with the secretary of state proving I am in business in order to qualify for this.
My training includes,
Reference letter uploads, 3 references are required, letters are preferred (optional)
Will you teach family members or clients things to do at home in between sessions, such as self-massage techniques, how to play a game with their children, or other home program assignments to help with goals?
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