Home Instead is looking for a Nurse 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.  Our goal to help seniors are in place while increasing their quality of life.


We are part of the largest senior Home Care agency in the world, onboarding and training is provided.

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 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 in the case of an emergency 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 5 days per week and 20 to 30 hours per week during regular business hours 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
 

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:
 

Incident                                     City/State                                                            Result     

 
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.
 
________________________________________________________                                  ____________________
 

APPLICANT SIGNATURE                                                                                              DATE