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Home Instead is looking for a Nurse Supervisor to become a part of our team and join our mission of enhancing the lives of aging adults throughout our community. Home Instead provides a variety of services that allow seniors to remain in their home and meet the challenges of aging with dignity, care and compassion.
Likes working in a supportive team based environment and enjoys collaborating with other key players to enhance the lives of the seniors we serve.
Duties include, but are not limited to:
-Creating a Plan of Care based on in-home evaluation of the patient
-Monitoring and documentation of patient vital signs, psycho-social review relevant to the Plan of Care, systems review (neurologic, musculo-skeletal, integumentary, cardiovascular, pulmonary, gastro-intestinal, genito-urinary), nutritional status and advanced directives.
-Performing in-home CHHA Orientation based on the detailed Plan of Care
-Monitoring all CHHA Activity records
-Executing a Home safety review, including fall risk assessment
-Documentation of client and cargiver activities in operating system.
-Periodic patient evaluation and reassessment
-Clinical oversight of Home Instead in-home health care, personal care and companion services program including services rendered by its employees (certified homemaker home health aides and companions).
Qualified candidates must have the following:
Bachelor of Science Degree in Nursing
Experience working as a Director of Nursing or Nurse Supervisor for a Healthcare Service Firm is preferred but not mandatory.
Understanding of the Best Practices for Health Care Service Firms according to the New Jersey Division of Consumer Affairs and applicable federal and state regulations.
May be required to be available on-call after normal business hours and/or on weekends. On call means available to respond to questions from CHHAs, companions, patients or families concerning services via electronic communication or telephone, but does not necessarily require that the on-call individual be available to personally visit the client.
New Jersey Board of Nursing licensed Registered Nurse with education and community health nursing experience with progressive responsibilities in community health nursing.
This is a part-time position (Three to four days per week, 10 to 30 hours per week during regular business hours plus on-call evenings/weekends as needed, with competitive pay.
www.homeinstead.com/207
EMPLOYMENT APPLICATION
ELA Associates, Inc. d.b.a. an independently owned and operated Home Instead franchise
25 Main Street, Eatontown, NJ 07724
732-542-9004 (Phone), 732-542-9060 (Fax)
APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body may be required prior to employment.
PERSONAL INFORMATION
Today’s Date: ______________
Positions(s) Applied For: ____________________________________________________
Social Security Number: _______-_______-_______
Name: _______________________________ _________________________________ _____________________
Last First Middle
Current Address: _________________________________ _______________________ ______ ____________
Street City State Zip Code
Home Phone: (______) ___________________ Work Phone: (______) ______________________
Cell Phone: (______) _____________________ Alternate Phone: (______) ____________________
Other Names or Social Security Numbers Previously Used:
__________________________ _________________________ _____________ ________________________
Last First Middle Social Security Number
__________________________ _________________________ _____________ ________________________
Last First Middle Social Security Number
Emergency Contact(s): ____________________________________ (______) ____________________
Name Phone
____________________________________ (______) ____________________
Name Phone
Have you ever submitted an application here before? Yes / No If yes, when? _________________________________
Have you ever been employed here before? Yes / No If yes, when? ________________________________________
You have been given a copy of the job description for the position for which you have applied. Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation? Yes / No
How did you hear about our Home Instead franchise office? ______________________________________
Why are you interested in employment with us? __________________________________________________________
_________________________________________________________________________________________________
AVAILABILITY
Due to the nature of the business, no guarantee can be made as to the schedule or the amount of hours worked.
What date are you available to begin work? ___________
Please complete all areas of availability:
____Full-Time (30 or more hours/week) ____Part-Time (less than 30 hours/week) Hours/Week Desired: _____
EDUCATION
Please circle highest grade completed:
Grade School: 6 7 8 High School: 9 10 11 12 College: 13 14 15 16 16+
WORK HISTORY
Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.
MOST RECENT EMPLOYER
Are you currently working for this employer? Yes / No If yes, may we contact? Yes / No
__________________________________ ________________________ _______ ( _____ )_______________________
Company Name City State Phone Number
Dates Employed: From ___________ to ___________ _____________________________ ______________________________________
Job Title Supervisor's Name
______________________________________________________________________________________________________________________
Duties
$_____________ per __________________ ____________________________________________________________________________
Salary (Hour, Week, Month) Reason for Leaving
__________________________________ ________________________ _______ ( _____ )_______________________
Company Name City State Phone Number
Dates Employed: From ___________ to ___________ _____________________________ ______________________________________
Job Title Supervisor's Name
______________________________________________________________________________________________________________________
Duties
$_____________ per __________________ ____________________________________________________________________________
Salary (Hour, Week, Month) Reason for Leaving
__________________________________ ________________________ _______ ( _____ )_______________________
Company Name City State Phone Number
Dates Employed: From ___________ to ___________ _____________________________ ______________________________________
Job Title Supervisor's Name
______________________________________________________________________________________________________________________
Duties
$_____________ per __________________ ____________________________________________________________________________
Salary (Hour, Week, Month) Reason for Leaving
BACKGROUND
As a condition of employment all employees must be “Bondable”.
List states and counties of residence for the past seven (7) years:
________________________ ____________________________ ______________________ ____________________________
State County State County
________________________ ____________________________ ______________________ ____________________________
State County State County
Have you had any moving traffic violations? Yes / No If yes, please describe: _______________________________
Have you been convicted of a felony or misdemeanor in the past seven (7) years? Yes / No If yes, please describe:
1) _____________________________________________________________________________________________
2) _____________________________________________________________________________________________
REFERENCES (Do not include relatives)
Please complete all six references. Your application will not be considered unless six references are provided. Since we will contact these references, please notify them in advance.
CERTIFICATION AND RELEASE: I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT. I ALSO UNDERSTAND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN MYSELF AND ELA Associates, Inc. d/b/a Home Instead IS TERMINABLE AT-WILL, SO THAT BOTH THE COMPANY AND I REMAIN FREE TO CHOOSE TO END OUR WORK RELATIONSHIP AT ANY TIME FOR ANY OR NO REASON. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING.
________________________________________________________ ____________________
Registered Nurse RN (Monmouth County)
800 Broad St, Shrewsbury, NJ 07702
Job Description
Registered Nurse Compensation: hourly rate or flat per visit Part-time or per diem opportunity to grow into full time position.
Home Instead is looking for a Nurse Supervisor to become a part of our team and join our mission of enhancing the lives of aging adults throughout our community. Home Instead provides a variety of services that allow seniors to remain in their home and meet the challenges of aging with dignity, care and compassion.
Likes working in a supportive team based environment and enjoys collaborating with other key players to enhance the lives of the seniors we serve.
Duties include, but are not limited to:
-Creating a Plan of Care based on in-home evaluation of the patient
-Monitoring and documentation of patient vital signs, psycho-social review relevant to the Plan of Care, systems review (neurologic, musculo-skeletal, integumentary, cardiovascular, pulmonary, gastro-intestinal, genito-urinary), nutritional status and advanced directives.
-Performing in-home CHHA Orientation based on the detailed Plan of Care
-Monitoring all CHHA Activity records
-Executing a Home safety review, including fall risk assessment
-Documentation of client and cargiver activities in operating system.
-Periodic patient evaluation and reassessment
-Clinical oversight of Home Instead in-home health care, personal care and companion services program including services rendered by its employees (certified homemaker home health aides and companions).
Qualified candidates must have the following:
Bachelor of Science Degree in Nursing
Experience working as a Director of Nursing or Nurse Supervisor for a Healthcare Service Firm is preferred but not mandatory.
Understanding of the Best Practices for Health Care Service Firms according to the New Jersey Division of Consumer Affairs and applicable federal and state regulations.
May be required to be available on-call after normal business hours and/or on weekends. On call means available to respond to questions from CHHAs, companions, patients or families concerning services via electronic communication or telephone, but does not necessarily require that the on-call individual be available to personally visit the client.
New Jersey Board of Nursing licensed Registered Nurse with education and community health nursing experience with progressive responsibilities in community health nursing.
This is a part-time position (Three to four days per week, 10 to 30 hours per week during regular business hours plus on-call evenings/weekends as needed, with competitive pay.
www.homeinstead.com/207
EMPLOYMENT APPLICATION
ELA Associates, Inc. d.b.a. an independently owned and operated Home Instead franchise
25 Main Street, Eatontown, NJ 07724
732-542-9004 (Phone), 732-542-9060 (Fax)
INSTRUCTIONS: If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.Please read "Applicant Note” below. Complete all pages of this application.
Print clearly. Incomplete or illegible applications may not be accepted. If more space is needed to complete any question, use comments section on the back.
Application will be valid for 60 days.
Print clearly. Incomplete or illegible applications may not be accepted. If more space is needed to complete any question, use comments section on the back.
Application will be valid for 60 days.
APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body may be required prior to employment.
PERSONAL INFORMATION
Today’s Date: ______________
Positions(s) Applied For: ____________________________________________________
Social Security Number: _______-_______-_______
Name: _______________________________ _________________________________ _____________________
Last First Middle
Current Address: _________________________________ _______________________ ______ ____________
Street City State Zip Code
Home Phone: (______) ___________________ Work Phone: (______) ______________________
Cell Phone: (______) _____________________ Alternate Phone: (______) ____________________
Other Names or Social Security Numbers Previously Used:
__________________________ _________________________ _____________ ________________________
Last First Middle Social Security Number
__________________________ _________________________ _____________ ________________________
Last First Middle Social Security Number
Emergency Contact(s): ____________________________________ (______) ____________________
Name Phone
____________________________________ (______) ____________________
Name Phone
Have you ever submitted an application here before? Yes / No If yes, when? _________________________________
Have you ever been employed here before? Yes / No If yes, when? ________________________________________
You have been given a copy of the job description for the position for which you have applied. Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation? Yes / No
How did you hear about our Home Instead franchise office? ______________________________________
Why are you interested in employment with us? __________________________________________________________
_________________________________________________________________________________________________
AVAILABILITY
Due to the nature of the business, no guarantee can be made as to the schedule or the amount of hours worked.
What date are you available to begin work? ___________
Please complete all areas of availability:
____Full-Time (30 or more hours/week) ____Part-Time (less than 30 hours/week) Hours/Week Desired: _____
EDUCATION
Please circle highest grade completed:
Grade School: 6 7 8 High School: 9 10 11 12 College: 13 14 15 16 16+
| School Type | School Name | City, State | Major/Subject | # Yrs Attended | Graduate |
| High School | Y / N | ||||
| Vocational/Technical | Y / N | ||||
| College/University | Y / N |
WORK HISTORY
Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.
MOST RECENT EMPLOYER
Are you currently working for this employer? Yes / No If yes, may we contact? Yes / No
__________________________________ ________________________ _______ ( _____ )_______________________
Company Name City State Phone Number
Dates Employed: From ___________ to ___________ _____________________________ ______________________________________
Job Title Supervisor's Name
______________________________________________________________________________________________________________________
Duties
$_____________ per __________________ ____________________________________________________________________________
Salary (Hour, Week, Month) Reason for Leaving
SECOND MOST RECENT EMPLOYER
__________________________________ ________________________ _______ ( _____ )_______________________
Company Name City State Phone Number
Dates Employed: From ___________ to ___________ _____________________________ ______________________________________
Job Title Supervisor's Name
______________________________________________________________________________________________________________________
Duties
$_____________ per __________________ ____________________________________________________________________________
Salary (Hour, Week, Month) Reason for Leaving
THIRD MOST RECENT EMPLOYER
__________________________________ ________________________ _______ ( _____ )_______________________
Company Name City State Phone Number
Dates Employed: From ___________ to ___________ _____________________________ ______________________________________
Job Title Supervisor's Name
______________________________________________________________________________________________________________________
Duties
$_____________ per __________________ ____________________________________________________________________________
Salary (Hour, Week, Month) Reason for Leaving
BACKGROUND
As a condition of employment all employees must be “Bondable”.
List states and counties of residence for the past seven (7) years:
________________________ ____________________________ ______________________ ____________________________
State County State County
________________________ ____________________________ ______________________ ____________________________
State County State County
Have you had any moving traffic violations? Yes / No If yes, please describe: _______________________________
Have you been convicted of a felony or misdemeanor in the past seven (7) years? Yes / No If yes, please describe:
IncidentCity/StateResult
1) _____________________________________________________________________________________________
2) _____________________________________________________________________________________________
REFERENCES (Do not include relatives)
Please complete all six references. Your application will not be considered unless six references are provided. Since we will contact these references, please notify them in advance.
| Full Name | Phone Number | Best Time of Day to Call | Relationship | Number of Years Known |
| 1) | H ( ) W ( ) | AM / PM AM / PM | ||
| 2) | H ( ) W ( ) | AM / PM AM / PM | ||
| 3) | H ( ) W ( ) | AM / PM AM / PM | ||
| 4) | H ( ) W ( ) | AM / PM AM / PM | ||
| 5) | H ( ) W ( ) | AM / PM AM / PM | ||
| 6) | H ( ) W ( ) | AM / PM AM / PM |
CERTIFICATION AND RELEASE: I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT. I ALSO UNDERSTAND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN MYSELF AND ELA Associates, Inc. d/b/a Home Instead IS TERMINABLE AT-WILL, SO THAT BOTH THE COMPANY AND I REMAIN FREE TO CHOOSE TO END OUR WORK RELATIONSHIP AT ANY TIME FOR ANY OR NO REASON. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING.
________________________________________________________ ____________________