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Careers | Generations Home Care
Services
Complete List of Services
Alzheimers, Dementia, Parkinsons Care
Companionship
Medication Reminders & Safety
Personal Care & Hygiene
Physical Assistance & Homemaking
Places We Care
Respite Care for Family Caregivers
Special Care Situations
About
Generations’ Promise To You…
Testimonials
Costs
Our Rates
Average Cost of Care
The Veteran’s Aid and Attendance Pension
Medicare & Medicaid
Private and Long Term Care Insurance
Self Pay or Private Pay
Custom Care Plans
Workers’ Compensation
Family Learning Center
Making a Difference
Interactive Learning Sessions
How to Prevent Falls by Playing Bingo!!!
Reduce the Risk of Falling
Useful Links for Family Care
Top 10 Questions to Ask When Hiring a Home Care Agency
“Family Caregivers Lose $300,000 in Income Over Their Lifetime”
FAQ
Arizona Home Care Blog
Careers
Contact Us
Careers Form
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Careers Form
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Name
*
First
Last
*
City
State / Province / Region
Contact Info
*
Primary Phone Number
Email Address
*
Email Address
Resume and Experience
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Can you provide proof, if hired, of your identity and eligibility to work in the United States?
*
Yes
No
Are you at least 18 years old?
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Yes
No
Date Available to Start:
*
Salary or Wage expected?
*
*
Per Hour
Per Year
Please list any additional information you feel may be helpful to us in considering your application.
We are interested to know how you found us. Please tell us your source below:
*
LinkedIn
Monster.com
Indeed.com
Twitter
SimplyHired.com
Private Employment/Temp Agency
GlassDoor.com
Newspaper/National Publication
US.Jobs
Radio/TV Advertisement
CareerBuilder
Internet - Job Website
Walked In Onsite
Employee
Facebook
MyCNAJobs
Other
Schedule
Work Preferences (Check all that you are interested in):
*
Full Time
Part Time
PRN
What shift schedule(s) are you looking for?
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Day Shift
Evening Shift
Night Shift
Have you checked all shifts you are willing to work?
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Yes
No
Please indicate what days you are available to work:
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What Professional License Certifications Do you Have?
Check all that apply:
*
DL - Drivers License
SSC - Social Security Card
CNA - Certified Nursing Assistant
HHA - Home Health Aide
LNA - Licensed Nursing Assistant
ALCG -Assisted Living Certified Caregiver (NCIA Board - 104 Hour Program)
DCW - Direct Care Worker (Home and Community Based Medicaid Program)
Arizona Level One Fingerprint Card
Current TB Test
CPR
First Aid
Expiration Date
MM slash DD slash YYYY
If you are a CNA, LNA or HHA, your license must be in good standing. Do you have a valid professional license?
Yes
No
License Type
*
Certified Nursing Assistant
Licensed Practical Nurse
Registered Dietician
Registered Nurse
State Tested Nurses Aide
Nursing Home Administrator
Assisted Living Administrator
Respiratory Therapist
CPR Certification
Certified Medication Technician
Certified Medication Aide
Certified Activities Director
Social Worker
CDL
Massage Therapy
Speech Language Pathology
Occupational Therapy
Physical Therapist
Physical Therapist Assistant
Certified Public Accountant
License Number/ID
*
Issuing College, Technical School, or Organization
*
Issue Date
*
Month
Day
Year
Expiration Date
*
Month
Day
Year
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Do you have another professional license or certification?
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Yes
No
If yes, what license or certification?
If yes, what license or certification?
Has your license, registration, or certification ever been investigated, revoked, suspended, limited, or subject to discipline, by any board or governing authority?
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Yes
No
If yes, please explain:
Education
*
please select the highest education level you have completed:
Primary School
High School
College
Name of School
*
Address
*
City
State / Province / Region
What was your GPA/Scale (i.e. 3.5/4.0)
*
Do you have a degree?
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Yes
No
If so, what Degree? (AS, BS, etc.)
Field of Study
Work Experience and Skills
*
Please select the work experience or skills from the list you have.
Geriatric
Dementia / Alzheimer’s
Parkinson's Disease
Cancer Care
Veterans Care
Dialysis
Diabetes
COPD
Ostomy Care
Stroke / Cardiac
MS
ALS
Assistance with Activities of Daily Living (ADL's)
Transferring
Hoyer
Feeding Tube
Bed Bound
Traumatic Brain Injury
Spinal Cord Injury
Children with Disabilities
Adults with Disabilities
Fall Prevention / Client Safety
Meal Planning / Preparation
Homemaking / Housekeeping
Companionship
Respite
Direct Care Worker (DCW) - Medicaid
Community Healthcare Worker (CHW)
Professional Caregiver
Caregiver for a Loved One
Other
Previous Facility Types Worked
*
Please select the type of facilities you have worked in before.
Hospital
Hospice
Skilled Nursing Home
Assisted Living
Independent Living
Residential Treatment
Rehab
Group Home
Private Duty (Private Home)
Live-In (Private Home)
Overnight Care (Private Home)
Other
Employment Status
Have you ever applied at Generations Home Care?
*
Yes
No
If yes, what year?
Reference Information
Have any of your relatives ever worked for this company?
*
Yes
No
If yes, please provide the name:
Do any of your friends work here?
*
Yes
No
If yes, please provide the name:
Please list three references of a professional nature
Name:
Relationship:
Company:
Phone Number:
Name:
Relationship:
Company:
Phone Number:
Name:
Relationship:
Company:
Phone Number:
EEO Information
Please identify your gender.
Male
Female
Please identify your ethnicity.
Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.)
Yes
No
If checked no, which of the following best describes your ethnicity?
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Two or more races - which DO NOT include Hispanic or Latino
This company is an Equal Opportunity/Affirmative Action employer and subject to certain reporting and affirmitve action requirements. The information required on this page is requested only so that we may meet our Equal Opportunity/Affirmative Action obligations. Your completion of this form is purely voluntary and will not, in any way, affect your consideration for employment. Any information you provide on this page will be stored separately from your job application.
Check here, if you do not wish to provide the information requested.
Criminal Convection History
*
I agree that I have not been convicted of a crime such as molestation, rape, battery, neglect, exploitation, felony theft, or any other substantially related crime to a dependent population.
I Agree
I Don't Agree
- "Molest" means to annoy or to meddle with so as to trouble or harm; to make improper sexual advances.
- "Rape" means to have sexual intercourse with a person forcibly and with consent; any sexual, violent or outrageous assault.
- "Battery" means knowingly or intentionally touching another person in a rude or angry manner(i.e.m grabbing or shoving in a rude, angry manner; slapping or hitting; and knocking someone to the floor).
- "Neglect" means placing a dependent in a situation that may endanger his/her life or health (i.e., abandoning or cruelly confining a dependent or depriving a dependent of necessary support, including food, clothing, shelter or medical care.
- "Dependent" means a person of any age who is mentally or physically disabled who is under the care of another person.
- "Exploitation" means unauthorized use of an adult dependent or his/her resources for one's own profit or advantage, or for the profit or advantage of another.
- "Theft" means a criminal act in which property belonging to another is taken without that persons consent.
Application Agreement
I fully understand that I must report all accidents to my immediate supervisor and to Southland Home Health and Hospice. I also understand that I must wear all required personal protective equipment (PPE). The penalty for not wearing PPE is disciplinary action, up to and including termination. In signing this application, I certify that I have read and fully understand the questions asked in this application and that all answers given by me are true, accurate, and complete. I also understand that the omission, concealment, or misrepresentation of any fact on this application or during any interview for employment may jeopardize my chances for employment and be cause for my immediate dismissal from employment. I give Southland Home Health and Hospice permission to use any information in this application to enable it and its agents to verify the information contained in this application 1 also authorize present and former employers, educational institutions I have attended, credit agencies, all references, and any other persons to answer all questions asked by Southland Home Health and Hospice with regard to any of the subjects covered by this application. I also understand that in connection with my application for employment or my employment, Southland Home Health and Hospice may conduct a criminal background investigation and that my employment may be contingent on the results of such investigation. I release Southland Home Health and Hospice, its agents, and affiliated entities, as well any person or situation that provides any information about me, from any and all liability whatsoever resulting from any such investigation or the disclosure or such information. In consideration of my employment and of my being considered for employment by Southland Home Health and Hospice, I agree to abide by all rules and regulations, which I understand are subject to change at any time for any reason without prior notice. I also understand that if employed, I will be an employee at will and employed for no definite period of time. I understand that either Southland Home Health and Hospice or I can terminate my employment at any time, with or without cause and with or without advance notice. I further understand that no communication, whether oral or written, by any representative or Southland Home Health and Hospice, has the authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing. I am willing to submit to submit to a physical examination, including the analysis for the detection of the use of unlawful drugs or substances in accordance with the applicable laws. If I receive an offer of employment I agree that my continued employment may be contingent on the results. I understand that Southland Home Health and Hospice is not involved in the day-to-day supervision or decision concerning patient care or dentistry. This remains with the Professional as part of the Professional's practice, The Professional fully indemnifies Southland Home Health and Hospice against any and all liability and responsibility associated with his or her professional duties. The Professional maintains his or her license as required by law, professional liability coverage and other responsibilities as found under state prime contract law.
I have read, understood and agree to the above statement and to the terms and conditions for the use of electronic signature.
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