PSW/Companion Employment Application

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Full Name* This field is required.
First Name
Last Name
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Position applying for* This field is required.
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Email* This field is required.
example@example.com
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How many days are you available to work?* This field is required.
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Do you have a Vulnerable Sector Screening (VSS) within last 6 months?* This field is required.
YESNO
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You need to apply for a new Vulnerable Sector Screening (VSS). Refer to your Regional Police Service website for more information.
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Do you have a tuberculin skin test (also called a Mantoux tuberculin test) within last 12 months?* This field is required.
YESNO
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Contact your doctor or local public health office to receive a tuberculin skin test.
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Do you have a valid Standard First Aid & CPR Certificate Health Care Provider (HCP or Level C) level?* This field is required.
YESNO
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Contact Ontario based First Aid and CPR training provider to complete Standard First Aid & CPR HCP/Level C training course.
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Do you have a personal record of the immunizations (vaccines) you have had in your lifetime?* This field is required.
YESNO
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If you do not have a card or booklet with your immunizations, contact your doctor, nurse or local public health office.
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Do you have a Personal Support Worker (PSW) Certificate from an educational institution approved by the Ministry of Training, Colleges and Universities or the National Association of Career Colleges (NACC)?* This field is required.
YESNO
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Highest level of education completed?* This field is required.
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Have you ever been convicted of a crime in a court of law?* This field is required.
YESNO
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Please explain* This field is required.
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Normal
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Ok
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Are you available to work?* This field is required.
Day
Evening
Night
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Date you can start* This field is required.
Date
Day
Month
Year
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Salary desired (hourly)* This field is required.
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Do you own a car?* This field is required.
YESNO
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Are you fluent in a foreign language?* This field is required.
YESNO
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What language(s)?* This field is required.
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How did you hear about this position?* This field is required.
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Country
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Telephone number* This field is required.
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Cover Letter
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Resume* This field is required.
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Welcome to our clinical quiz. In order to complete your employment application, you will need to answer a number of multiple choice questions, each providing a number of possible answers. Select the answer you think is correct by clicking it. To begin, click the NEXT button.
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1. You suspect a client is being abused. What should you do?* This field is required.
Tell the family.
Tell your supervisor.
Call the police.
Ask the person if he or she was abused.
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2. Mrs. Howard always tries to get up without help. You should do the following except:* This field is required.
Remind her to call for assistance.
Check on her often.
Help her to the bathroom at regular intervals.
Decide to keep bedrails up.
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3. Which statement about feeding a client is false?* This field is required.
Ask if he or she wants to pray before eating.
Use a fork.
Ask the person the order in which to serve foods.
Engage the person in pleasant conversation.
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4. A resident in the facility you work at asks for your telephone number. You should:* This field is required.
Give her your cellphone number only.
Give your supervisor's cellphone number so she can deal with the issue.
Explain that you cannot give your phone number out to residents.
Ignore her and ask the nurse to give her a sedative.
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5. Which of the following is the first sign of a pressure ulcer?* This field is required.
White or reddened skin.
Blisters are apparent.
Bone is protruding from the wound.
Skin tears.
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6. Which statement promotes communication?* This field is required.
“Don't worry.”
“Everything will be just fine.”
“This is a good facility.”
“Why are you crying?”
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7. Mr. Smith’s hearing aid is not working. First, you should:* This field is required.
Check if it is turned on.
Have it repaired.
Wash the hearing aid with soap and water.
Change the batteries.
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8. To prevent falls, you should do the following except:* This field is required.
Wipe up spills right away.
Turn on night lights.
Encourage the use of hand rails and grab bars.
Keep the bed in the highest position.
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9. When confronted by an aggressive client you should not:* This field is required.
Touch the person.
Stand about two meters away from the client.
Talk to the client calmly.
Quickly leave the room or house if you think you are in danger.
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10. When brushing Mrs. Lam's teeth, which of the following does not need to be reported?* This field is required.
Bleeding, swelling, or redness of the gums.
Irritations, sores, or white patches in the mouth or on the tongue.
Dry, cracked, swollen or blistered lips.
Food between teeth.
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11. Which of the following measures will not help Mr. Smith to rest or sleep?* This field is required.
Having him void before rest or sleep.
Helping him to assume a comfortable position.
Helping him to ambulate before rest or sleep.
Letting him choose sleep attire.
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12. Mr. Dunn has moderate dementia. He tends to wander. You should do the following except:* This field is required.
Make sure door alarms are turned on.
Make sure he wears a medical bracelet.
Help him with exercise as ordered.
Tell him what areas are safe for wandering.
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13. Which of the following will not help normal elimination?* This field is required.
Help the client assume a normal position for urination as soon as requested.
Provide privacy.
Help the client to the bathroom or commode, or provide the bedpan or urinal as soon as requested.
Tell the client to hurry up as their roommate is waiting for the bathroom.
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14. A person has an indwelling catheter. Which is incorrect action?* This field is required.
Tape any leaks at the connection site.
Keep the drainage bag below the level of the bladder.
Make sure the tubing is free of kinks.
Report complaints of pain, burning, the need to void, or irritation immediately.
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15. You have been told to follow contact precautions with one of your residents. Therefore, this resident’s soiled linen should be:* This field is required.
Thrown away.
Taken directly to the laundry.
Bagged prior to removing it from the room.
Placed in the linen hamper.
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16. In the event of a fire in a resident’s room, your first action should be to:* This field is required.
Remove the resident to a safe place.
Get the fire extinguisher.
Sound the fire alarm.
Notify the head nurse.
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17. While you are walking with Mrs. Davis in the hallway, she complains of dizziness. Your first response should be to:* This field is required.
Assist her into a nearby chair and call for help.
Assist her to the floor and go get help.
Ask Mrs. Davis to breathe deeply and reassure her that everything will be fine.
Encourage Mrs. Davis to continue walking because she needs the exercise.
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18. After applying a restraint to a resident:* This field is required.
Try to ignore the person’s complaints; he or she just wants attention.
Check the restraint every 6 hours.
Change the restraint once a day.
Remove the restraint at least every 2 hours.
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19. If a person is coughing but able to breathe, you should:* This field is required.
Administer oxygen.
Use a finger sweep to remove the object that is obstructing the person’s airway.
Perform the Heimlich manoeuvre.
Stay with the person and allow him or her to continue coughing.
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20. Many falls in older adults are related to:* This field is required.
Tripping.
Wearing slippers.
The urge to urinate.
Barriers between the bed and bathroom.
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21. You show respect to a resident when you:* This field is required.
Knock before entering his or her room.
Close the door and pull the privacy curtain when you are providing care.
Handle the person’s personal belongings with care.
All of the above.
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22. When assisting a person with a shower, you should:* This field is required.
Use a bath blanket to prevent falls.
Use a shower chair if the person is weak or unsteady.
Run the water until the temperature reaches 38.6 C.
Wear waterproof personal protective equipment to protect yourself from getting wet.
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23. Mr. Campi, one of your elderly residents, is very hard of hearing. What should you remember when you are talking to Mr. Campi?* This field is required.
You should sit or stand so that Mr. Campi has a clear view of your face, and you should avoid chewing gum or speaking quickly.
If you think that Mr. Campi has not completely understood what you are saying, you should demand that he repeat it back to you so that you can correct his mistakes.
If you do not understand what Mr. Campi has said, you should just let it pass. Letting him know that you did not understand might embarrass or frustrate him.
There is no point in talking to Mr. Campi. He cannot hear you anyway. It is better to just write everything down.
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24. When helping a person with dementia with her activities of daily living (ADLs), such as bathing, eating, and dressing, what should you remember?* This field is required.
Adhere to an established routine as much as possible.
Prepare for the procedure ahead of time.
Many ADLs are very frightening or frustrating for the person with dementia.
All of the above.
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25. When communicating with a person with dementia, what is the best approach to take?* This field is required.
Speak loudly and quickly to get the person’s attention.
Avoid touching the person or using hand gestures.
Speak clearly, in a calm tone of voice.
Avoid talking about the past.
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Total
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References:

List two professional references that you have known for at least one year. List at least one previous supervisor.
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May we contact your references?* This field is required.
Yes
No
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Reference 1* This field is required.Name of Reference
First Name
Last Name
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Relationship* This field is required.
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Email* This field is required.
example@example.com
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Reference 2* This field is required.Name of Reference
First Name
Last Name
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Relationship* This field is required.
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Email* This field is required.
example@example.com
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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 by Accela Staff Inc., my employment may be terminated at any time. 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 Accela Staff Inc.

Accela Staff Inc. may conduct an employment verification, education verification, driver’s license check, criminal background check, reference check, and/or other inquiries regarding my background and employment history, including information as to my personal character, general reputation, job performance, and other qualities pertinent to my prospective service. I hereby consent and authorize Accela Staff Inc. and/or their designated agents to make such inquires, and I authorize without reservation, the release of such information to their client and/or their designated agents, and release Accela Staff Inc. and the provider of such information from any and all liability for damages arising from the investigation and disclosure of the requested information. I will allow a photocopy/fax/email copy of this authorization to be as valid as the original.

In consideration of my employment, I agree to conform to the Accela Staff'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 Accela Staff's decision.
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Date* This field is required.
Date
Day
Month
Year
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Signature* This field is required.
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