Mentors of Michigan Direct Care Application

APPLICATION FOR EMPLOYMENT

AN EQUAL OPPORTUNITY ORGANIZATION

If you are an individual with disability and need reasonable accommodation to participate in the hiring process, please contact Aleshia Devereaux, Director of Human Resources @ Mentors of Michigan

Please note: Applicants must complete the following information completely, even if attaching a resume.

Note: A conviction will not necessarily bar employment. Each conviction is judged on its own merits with respect to time, circumstances & seriousness.

CONDITIONS OF EMPLOYMENT

I certify that the responses entered by me on this employment application are true and complete. I understand that any misleading or incorrect statements may render this application void. I agree the company is not liable in any respect if my employment is terminated because of false statements, answers, or omissions made by me in the application

 

I also understand that, if accepted for employment, I shall be required to provide proof of identity and eligibility to work in the United States (in compliance with the Immigration Reform & Control Act of 1986), as a condition of employment, In connection with this application, I authorize all corporations, companies, credit agencies, education institutions, persons, law enforcement agencies, military services, and former employers to release information that they may have about me to THIS ORGANIZATION or its agents and release them from any liability for doing so. Also, I understand that a medical exam and/or criminal/abuse/neglect checks may be performed for programs for which licensing and/or certifying entities require them and that any offer for employment and continued employment is contingent upon receipt of satisfactory clearance.

I understand that this application does not, by itself, create a contract of employment, I also understand that an acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. I further understand and agree that, if accepted for employment by THIS ORGANIZATION or its subsidiaries, I will have no expectation of privacy in property owned by the organization. I also understand that initial employment is probationary for a specified period of time as per the company policy, and that successful completion of probation does not guarantee permanent employment.

I declare that I am not a pedophile or childe molester and that I have not perpetrated physical abuse, sexual abuse, emotional abuse or neglect. I understand that if employed, I have been hired at the will of my employer and that my employment may be terminated at any time, with or without cause and with our without notice.

Record of Employment (last 10 years)

 

THIS ORGANIZATION will confirm dates of employment, positions held, reasons for leaving with prior employers. Explain ALL gaps in employment and other information relevant to eligibility, qualifications and suitability with prior employers in the “Additional Information: sections.

REFERENCES

You are authorizing the collection of any information concerning past employment and personal references. Please complete the following: 2 business and 1 personal reference and sign below.

https://www.uscis.gov/sites/default/files/document/forms/i-9-paper-version.pdf

DIRECT CARE WAGE INCREASE AND PAY RATE ACKNOWLEDGEMENT

 

I am an employee at mentors of Michigan and understand that my starting wage as a Direct Care Staffis $10.00 per hour, plus a $.50 per hour to cover the Direct Care Wage Increase established by Easter Seals and/or MORC, paid as a bonus on hours worked after Mentors of Michigan receives from CMH. My wage will start at $10:50 per hour and may increase after a 90 day periodic review based on performance

POLICY ACCPTANCE WAIVER

I understand that I am responsible to read the Personnel Policies Manual or have someone explain it to me in language that I understand. I agree to all the conditions set forth in the manual. I also understand that I have no reasonable expectation to believe these policies will remain in effect indefinitely. I understand that the employer reserves a unilateral right to change, withdraw, or add to these policies at any time, and that the policies contained in this manual supersede and replace all previous personnel policies of the agency. I understand a copy of the personnel policies manual is available at the work site or area office. Further, I understand that any infraction of said policies may result in disciplinary action deemed appropriate by my supervisor.

 

I understand that it is my responsibility to read and become familiar with the contents of "Your Rights", which is published by the Office of Recipient Rights for the State of Michigan. I agree to abide by these policies and will report any/all infractions to Mentors of Michigan and/or the Office of Recipient Rights immediate.

 

I also understand that it is my responsibility to read and become familiar with the Personnel Policy Book and all policies contained within. I agree to follow all policies and procedures within these manuals and will be held accountable for all information contained in them.

 

I also understand that  there  are many  updates  and  new  policies  added  continuously  and   it  is my responsibility to read and become familiar with the updates as well as the new policies.

DENIAL OF EXISTENCE OF CRIMINAL HISTORY

AS REQUIRED BY PUBLIC ACT 29

 

I have been advised by Mentors of Michigan that it is necessary to conditionally employ independently contract and/grant clinical privileges to me prior to receiving all of the results of the state and national criminal history background information required by Public Act 29 of 2006. Accordingly, I make the following representation while this information is obtained and analyzed:

 

1.      I swear under penalty of law that I have not been convicted of a felony or misdemeanor within the application time period that makes me intelligible, by law to work for this organization. I have reviewed the attached list of felonies and misdemeanors prior to making this representation.

2.      I am not the subject of an order or disposition under section 16b of Chapter IX of the code of criminal procedure, 1927 PA, 175, MCL 769.16(b) relating to finding of not guilty by reason of insanity,

3.      I have not been the subject f a substantiated finding of neglect, abuse, or misappropriation of property by a state or federal agency pursuant to an investigation arising in a skilled nursing facility and conducted in accordance with 42 USC 1395i-3 or 1396r.

4.      I agree that, if the information in the criminal history investigation conducted by this organization does not confirm my statements, my employment, contract or clinical privileges will be terminated unless and until I can prove that the information is incorrect. I further agree that if this results in a period of unemployment, suspension, or leave of absence, it will be without compensation and without fringe benefits.

5.      I understand the conditions set forth in Public Act 29 of 2006 that result in my termination and agree that these conditions are in fact good cause for termination.

6.      I am aware that the provision of false information regarding my identity or criminal history is a crime punishable by fines and/or imprisonment.

PHOTOGRAPHY POLICY

 

All residents and employees of Mentors of Michigan facilities must sign an authorization to photograph. This will allow Mentors of Michigan to use photographs for public relations, promotion, advertising, resident programming, and/or retaining of records of Mentors of Michigan.

 

I,  an employee of Mentors of Michigan, understand and agree to the above stated policy. I am aware that my photograph may be used for promotional use, advertising, resident programming, and/or retaining record for Mentors of Michigan.

MENTORS OF MICHIGAN

AT-WILL NOTIFICATION

 

Mentors of Michigan and employee both acknowledge and understand that the relationship established is at-will and that the employer expressly reserves the right to terminate the employee at any time without cause and without notice.

 

By signing this document you are stating that you have read and are aware of the rules and regulations stated in the Personnel Policy Manual regarding At-Will employment with Mentors of Michigan and understand this agreement.

 

The employee understands that Mentors of Michigan is an At-Will company and that they can be terminated at any time at the discretion of the employer.

MENTORS OF MICHIGAN

TRAINING ACKNOWLEDGEMENT FORM

 

I understand that all Mentors of Michigan employees must be fully trained within 30 days of hire and ongoing thereafter. I also understand that Administration will sign me up for necessary training classes upon hire. After the initial training, I will be signed up for refresher classes as required to stay current with my training. I must attend all training classes as acheduled. In the event that I am signed up for class and do not attend, I will be immediately removed from  all schedules and will not be permitted to work until such time as the training requirement has been met regardless of my current training expiration date. If I prefer to get the training elsewhere, I may so at my own expense. However, the training must be approved by Mentors of Michigan and must be received in the office prior to any scheduled training classes to be exempt from attendance. Required trainings are as follows:

 

·       Introduction to support services (Including Person Centered Planning) – Specialized Residential Needs to be updated every 3 years, Person – Centered Planning to be updated annually

·       Limited English Proficiency – update annually

·       Working with People 1 and 2 – update every 3 years

·       Nutrition

·       Environment Emergencies – update every 3 years

·       CPR – update every 2 years

·       First Aid – update every 2 uears

·       HIPAA – update annually

·       Recipient Rights – update annually

·       TB – update annually

·       Physical – update annually

·       Any other as demand necessary

 

If I am not able to attend the training class as scheduled, I, the employee must call TTI at (248) 524-8801 no later than a.m. on the day of the training class or I will be considered no-call, no-show. I must also call Administration at (248) ----0964 to convey my absence so as to reschedule the required class.

 

It is clear that I must arrive to training class on time. If I am late to class by 15 minutes or more for any reason, I will not be permitted into class and will be considered no-call, no-show.

 

All no-call, no-shows will be charged a $25.00 fee per occurrence which will be deducted automatically from my paycheck if fees due cannot be deducted from my paycheck due to insufficient funds, I agree to pay Mentors of Michigan $25.00 concurrence.

 

Mentors of Michigan may deduct $25.00 from any paycheck for each no-call, no-show occurrence to a training class scheduled any time during my employment.

 

It is also clear to me that all certifications must be turned in and faxed to the office in the current pay period to receive pay for training hours. If I, the employee, do not turn in my certificate within the current pay period, I understand that I will not receive payment for those hours, but that the certificate of completion must still be turned in even if late to be completed for my training requirements and to retain my position.

 

MENTORS OF MICHIGAN

CONDITIONAL JOB OFFER

 

This good faith offer is conditioned upon the organization’s ability to successfully establish eligibility for employment, independent contract, or clinical privileges on a timely basis. The eligibility determination is made at the sole discretion of Mentors of Michigan and will be based not only on the organization’s policy on good moral character and references but also the information obtained through the mandatory background check and fingerprinting requirements imposed by Public Act 29.

 

This conditional offer is also conditioned upon the applicant’s full cooperation with the production of acceptable personal identification, obtainment of signed releases, consent forms, criminal history records, fingerprints and the obtainment of any other information required by policy or law. Failure to comply fully with all the requirements within 14 business days will result in the automatic withdrawal of this offer.

SUPPORT OF ABSTINENCE AGREEMENT

 

As staff of Mentors of Michigan, we are all expected to facilitate the spirit of abstinence by modeling avoidance of substances such as street drugs and excessive use of alcohol. As our clientele is vulnerable to influence and many residents have great difficulty with decision making in their best interest. Mentors of Michigan must be an advocate for each resident in assuring their safety and wellbeing.

 

Substances such as marijuana and any use of alcohol may well create behavioral outbursts that could endanger the resident, staff, and other residents. A brain-injured individual’s body chemistry is more vulnerable to these mood-altering substances than a non-injured person. Many TBI residents appear physically to be OIK but their “Hidden Injury” makes them act unpredictably and possibly violent when they drink alcohol or use marijuana.

 

It is the policy of Mentors of Michigan to perform random drug screens on staff and residents to ensure a drug free environment in support of the rehab process. Consequences for any detectable amounts of these substances in staff’s blood testing may result in termination of employment.

 

I have read this statement and I understand this policy and its intent and agree to not expose the residents at Mentors of Michigan to street drugs or alcohol

APPLICANT RELEASE

 

Please submit a resume with this Employment Application.

 

In connection with my application for employment (including contract for services) and a condition of continuing employment. I understand t ha investigative background inquiries are to be made on me including consumer credit, criminal convictions, motor vehicle, and other reports. These reports may include information as to my character, work habits, performance, education and experience along for reasons for termination of employment from previous employers. Further, I understand that the company will be requesting information from various Federal, State, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences as well as claims involving me in the first files of insurance companies.

 

I authorize without reservation, any party or agency contracted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. I hereby consent to obtaining the above information from this organization and/or any of their agents. This authorization and consent shall be valid in original, fax, or copy form.