• Pre-Interview Agreement

    Comfort Keepers 292

  • This agreement is entered into on this *day of   *,*   between, Comforting Times, LLC dba Comfort Keepers, hereby known as (employer) and   *   *   , hereby known as the applicant.

  • 1. Applicant understands that if offered employment by the employer she/he will have to submit to a drug screening.

    2. Applicant understands that if offered employment by the employer she/he will have to submit to a background screening at the cost of $60.00. This cost will be payroll deducted from the first three payrolls in the amount of $20.00 per payroll.

    3. Applicant understands that if offered employment by the employer that they must be willing to drive up to 20 miles radius drom current place of residence. Anything distance traveled in excess of 20 miles one way will be reimbursed $0.30 per mile over 20 miles.

    4. Applicant understands that they may sign a waiver to the mileage clause in order to obtain more hours.

    5. Applicant understands that they must have a current Tuberculosis Test hereby known as TB Test, on file with CK office at all times.

    6. Applicant understands that if offered employment by the employer, that they must have a valid drivers license at all times during employment with Comfort Keepers. Must notify CK office if license is revoked or suspended.

    7. Applicant understands that if offered employment by the employer, that they must have active/current automobile insurance on their POV at all times during their employment with Comfort Keepers. If for any reason that the automobile insurance is canceled, they must notify CK office immediately.

  • I   *   fully understand and agree to the aforementioned requirements, and would like to continue with the interview process

  • An Equal Opportunity Employer

    Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, or marital status, or the presence of a non-related medical condition or disability. All questions must be answered and application signed. Any application that does not provide requestedinformation will be automatically rejected.
  • Date of Application*
     - -
  • Referral Source*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • What date are you available for employment?*
     - -
  • Type of employment desired: (check all that apply)*
  • Are you able to meet the attendance requirements of the position?*
  • Have you previously applied for a position at Comfort Keepers?*
  • Have you previously worked at Comfort Keepers?*
  • Are you eligible to work in the United States (Proof of eligibility will be required before you can be employed)*
  • If you are under 18, can you furnish a work permit?*
  • Have you ever been convicted of/or plead guilty to a crime (other than minor traffic violations)?*

  • Please note that in order to be hired by Comfort Keepers, you must be Bondable.)
  • If the job requires, do you have a valid driver's license?*
  • Have you had any moving violations in the past 3 Years?*
  • Do you have any relatives currently employed by Comfort Keepers?*
  • Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodations?*
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  • Have you ever had a license or certification revoked?*

  • Employment History

    List your last three (3) employers, assignments or volunteer activities, starting with the most recent, Including military experience. Explain any gaps in employment in comments section below
  • Format: (000) 000-0000.
  • May we contact for reference/verification*
  • Format: (000) 000-0000.
  • May we contact for reference/verification*
  • Format: (000) 000-0000.
  • May we contact for reference/verification*

  • References

    List name and telephone number of three business/work references that are not related to you and are not previous supervisors. If not applicable, list three school or personal references that are not related to you, whom have knowledge of your work ethic, experience and abilities.
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  • I certify that the facts contained in this application and/or interview(s) are true and complete. Any misrepresentation or falsification of information or significant omissions will be the cause of rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date.

    I understand that, if employed, my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without prior notice. No representative of Comfort Keepers other than the owner(s) is authorized to make any assurance or promise of continued employment and any such assurance must be in writing signed by the owner(s).

    If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct of Comfort Keepers.

    This application will remain on active file for 60 days. If I am hired within this period, this form will be transferred to my individual personnel file. If I am not hired or have not heard from this employer within 60 days, this application is no longer active and I will need to reapply for employment if I wish to be considered for a job with Comfort Keepers. 

    I give the employer and/ or its' agents, including consumer reporting bureaus, the right to investigate any and all statements made in this application for the purpose of employment ad retention of employment. This investigation may include, but not limited to, credit reports, criminal conviction records, motor vehicle driving records and previous employment history. Further, I hereby release from liability and hold harmless this employer, its representatives, all persons and organizations/companies for furnishing such information.

    If required, I agree to a drug testing prior and during employment or for post accident occurrences.

    The employer, Comfort Keepers, is an Equal Opportunity Employer. The employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law. 

    NOTICE: This is to inform you that as a part of processing your employment application, we may obtain a customer report and/or an investigative report which includes information as to your character, general reputation, personal characteristics, and mode of living. If an investigative report is requested, you have the right to make a written request within a reasonable period of time for a complete an accurate disclosure of additional information concerning the nature and scope of the investigation. By signing below, you acknowledge receipt of a copy of this notice and a copy of the "Summary of Your Rights under the Fair Credit Reporting Act".

  • Date
     - -

  • Applicant: Please do not write on this page. For Office Use Only

  • Interview Results

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  • Test Results

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  • Reference Checks

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  • Date
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  • Availability Sheet

    Please complete the following schedule and provide times that you are able to work for Comfort Keepers. We provide services 24 hours a day, 7 days a week. How you complete this form is very important. The work hours that are provided for you by Comfort Keepers are driven by two primary business issues, the needs of the clients and your availability to work.
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  • Total Requested Hours Per Week

  • Are you willing to do temporary fill-in hours until the hours you want to become available?
  • Are you available to be On-Call for additional income?
  • Are you to willing to work with clients who smoke?
  • Are you to willing to work with clients who have pets?

  • This sheet designates the times that I am committing myself to be available to work for Comfort Keepers. By signing this sheet, I agree any changes to my availability must be approved and signed by my supervisor and can only be changed every 90 days, if needed. I understand that there is no guarantee of hours. I understand that it can take time to reach and sustain my desired number of hours per week, and that multiple factors affect this goal including my availability, client requests, my skills, and my ability to please the clients to whom I am assigned. Nothing in this statement is to be construed as a direct, implied, or inferred contract of employment.

  • Date
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  • Caregiver Job Description

    Job Classification: Non-Exempt

  • Job Summary: Provides personal care and support services to clients in a Comfort Keepers established Personal Care Program. 

    Qualifications:

    High school diploma or GED preferred. Applicant must be bondable and meet or exceed the minimum qualifications for each of the fllowing background checks: Criminal Background Investigation, Motor Vehicle Driving Record, Professional and Personal Reference Checks, and give permission to submit to random drug and alcohol testing. Must have reliable transportation and fulfill assignments with reliability and punctuality. Applicant must have a valid driver's license and automobile insurance.

    Applicant must satisfactorily complete the Comfort Keepers training and orientation program, both in-house and online through our Relias learning system. Must accept responsibility for learning and adhering to Comfort Keepers policies and procedures; be able to function in the home setting with minimal direct supervision; and maintain satisfactory relationships with administrative staff, clients, and family members. Must be genuinely concerned about helping people and have high moral standards of honesty and integrity.

     
    Essential Functions:

    • Performs duties as assigned on the personal care service plan.
    • Assists the client with activities of daily living by providing any of the Comfort Keepers approved Personal Care activities including, but not limited to: bathing, dressing, toileting, grooming, oral hygiene, and/or ambulation.
    • Provides for a clean, safe, and healthy environment for clients and family members. Provides light housekeeping tasks including laundering of client's garments and linens and changing the bed.
    • Assists in meeting nutritional needs by providing meal planning, meal preparation, grocery shopping, dishes, and kitchen clean-up.
    • Assists the client with ambulation/transfers as specified in the plan of care.
    • Reminds client to take self-administered medication.
    • Observes and reports any changes in the client's mental, physical, or emotional condition or home situation to the immediate supervisor in a timely manner.
    • Establishes and maintains effective communication and a professional relationship with clients, family members, and coworkers.
    • Participates in in-service and continuing education programs, staff meetings, and client conferences as requested by the immediate supervisor.
    • Completed required documentation of service delivery and submits to the office in a timely manner according to policy.
    • Uses equipment and supplies safely and properly.
    • Maintains confidentiality regarding client information.
    • Other reasonable related duties as assigned.

    Knowledge, Skills, Abilities:

    • Must be able to follow verbal and written instructions and document services provided.
    • Ability to speak clearly so others can understand.
    • Excellent interpersonal abilities by being able to give full attention to what others are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
    • Evidence of the practice of a high level of confidentiality.
    • Actively looks for ways to help others.
    • Strong social perceptiveness by being aware of others' reactions and understanding why they may react as they do.
    • Strong organizational skills and adjusting actions in relation to others.

    Working Environment:

    In a client home setting and an automobile. Contact with blood or other body fluids may pose a risk for exposure to bloodborne pathogens and infectious diseases.

    Position Physical Demands:

    The work requires moderate physical exertion on a regular and recurrent basis, such as driving, assisting clients in transfer activities and ambulation, and light housekeeping. Regularly required to stand, sit, walk, talk, hear, see, reach, kneel, and crouch. Lifting only up to 25 lbs is permitted and may be required.

     

  • I,         acknowledge receipt and understanding of this job description, I realize that this reflects a general list of responsibilities of the position, as well as a general description of the working environment and physical demands of the position I have accepted. 

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