Nursing Positions Employment Application


Who We Are

Accredited Nursing has an established track record in the home care business that encompasses over twenty-five years of success.  We are extremely proud of our longevity and our ability to provide the ultimate in licensed and personal care services for people in need of home care.  We have offices in Woodland Hills, Los Angeles, Orange County, Pasadena, San Diego and San Marcos.

Our Mission

We are committed to providing quality services in the home environment for the ill, disabled, elderly and homebound.  We strive to deliver quality care at the most affordable prices.  As a responsible member of the community we provide substantial employment opportunities in professional, licensed, supportive and administrative capacities.

Our People Principles

Key to our successes are the outstanding professionals who make up our teams.  As our business expands, we continually look to increase our staff of qualified individuals.

We believe in:

25 Years AnniversaryWhat We Offer

In addition to our competitive salary and the knowledge that you will be working with an industry leader, we offer Medical/Dental Insurance, a 401-K Retirement Plan that allows you to contribute up to 25% of your pay before taxes, A California Benefits Program that allows you to choose from a variety of options, and Credit Union membership.  We also offer free Hepatitis-B Vaccine and CPR Training.
 

Opportunities are available for Full-Time, Part-Time and Diem staff.

 APPLICATION FOR EMPLOYMENT NURSING POSITIONS

Stop and Please Read*Please Note: Complete the form in its entirety.  Failure to so so may result with lack of review of your application due to missing information.   All fields are required information!  If you would like to personally complete an application in person, please call 800-974-1234 ask for Human Resources, thank you. 

 
 PERSONAL INFORMATION:
First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Phone:
Cell:
Pager:  
 EDUCATION:
High School Name:
City:
State:
Major:


 

College/University:
City:
State:
Degree:


 

Professional or Technical School:
City:
State:
Degree:

LICENSURE/CERTS. (If Applicable)

Type:
State:
Number:
Expiration Date:
Type:
State:
Number:
Expiration Date:
Years Of Relevant Experience:
Type Of  Experience:

 

 Employment Information:
How did you hear about Accredited?:

* (List Newspaper name, Search Engine, Friends Name, etc.)
Position Desired:
Hours Preferred:

Can you, With Or Without Reasonable Accommodation, Fully And Safely Perform The

Essential Duties Of The Position For Which You Have Applied?:

Yes     No

 

 EMPLOYMENT HISTORY:
(Start With The Most Current And Account for Past Five Years.  Please Include Supervisors' Names.)
Employment Dates:
to (MM/DD)
Employer:
Address:
Supervisor:
Supervisor Phone:
Reason for leaving:


 

Employment Dates:
to (MM/DD)
Employer:
Address:
Supervisor:
Supervisor Phone:
Reason for leaving:


 

Employment Dates:
to (MM/DD)
Employer:
Address:
Supervisor:
Supervisor Phone:
Reason for leaving:

PLEASE CHECK IF YOU DO NOT WANT US TO CONTACT YOUR PRESENT EMPLOYER.

 

 ACCURACY OF INFORMATION/BACKGROUND CHECK:

I hereby certify that the information is this application is correct and compete to the best of my knowledge. I understand that falsification or omission of any material information on this application or in the interviewers’ process or in my resume, or mature to pass a physical examination, may be stains cause for immediate termination if I have already received an offer of employment. I understand that this application will no longer be active or receive further consideration once the position for which I am applying has been filled, or I am employed but do not actively work for the Company for a period of six months or more.

I agree to have any of the statements herein as well as my background investigated by the Company or its agents. This authorization shall become immediately and shall remain in effect for a period of twelve months after the date of signing this authorization. I understand that were background invested may include, but is not limited to, reviewing my education, employment history, any public records, and personal references, weather through a search of my security number, name, or other identifying information. In consideration for reviewing my application and other related information, I hereby waive and release the Company, its employees and agents, and all other entities and persons from any claims I might have, including the defamation and invasion of privacy, arising out of any verbal or written inquires and/or any verbal or written responses related to investigation of my background as well as the use or disclosure of such information. I understand that a photocopy of this authorization is to be considered as valid as the original. I understand that by checking the checkbox is considered as valid.
PLEASE CHECK TO AGREE

 

 EMPLOYMENT "AT WILL" DECLARATION:

I agree that if employed, I will abide by all policies and procedures established by the company. I understand that my employment is “at will”, that I may resign at any time, that the Company may terminate my employment at any time, with or without cause, and that no employee or other representative of the Company has the authority to make an agreement contrary to the foregoing unless it is in writing and signed by the Company President. This constitutes my entire agreement with the Company with regards to the matters set fourth In this paragraph.
PLEASE CHECK TO AGREE

 

 LIQUIDATED DAMAGES:

By pressing the 'Submit' button on this form, I certify that all the information entered is true and complete to the best of my knowledge, and I understand that any false or missing job-related information may disqualify me from this position. 
PLEASE CHECK TO AGREE

 

 CONFIDENTIALITY AGREEMENT:

I agree to maintain confidentiality of all patient information including, but not limited to, manes and addresses of clients and referral sources, patient medical condition and course of treatment, rates, etc.; and I understand that my failure to do so may result in disciplinary action up to and including discharge.
PLEASE CHECK TO AGREE

 

 MEDICAL PROVIDER NETWORK (MPN):

California law requires us to provide medical treatment in the event you are injured at work.  Accredited will provide this care by using a Medical Provider Network (MPN).  I am aware that I must immediately notify the Company should I require treatment.  Additional information regarding the MPN is available on http://www.accreditednursing.com/ website. 
PLEASE CHECK TO AGREE.

 

 ACCURACY OF INFORMATION/BACKGROUND CHECK:

By pressing the 'Submit' button on this form, I certify that all the information entered is true and complete to the best of my knowledge, and I understand that any false or missing job-related information may disqualify me from this position. 

Date:
TYPE NAME TO SIGN:

 

Authorization for Release of Information

In connection with my application for employment/promotion/tenancy/care provider, including any contract for services, with you; I understand that a consumer report that may contain public information may be requested from TrustPoint, Inc.

I authorize, with reservation, any party or agency by TrustPoint, inc or one of its agents to furnish above mentioned information. 

I have a right to make a request to TrustPoint, Inc., upon proper identification, of the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me, which TrustPoint, Inc. has previously furnished within the two-year periods preceding my request.

Residents of California, Maryland, Minnesota, and Oklahoma only; you have the right to receive a copy of your consumer report.

I would like to receive a copy of my report? Yes   No

Date:
TYPE NAME TO SIGN:

 

 APPLICATION VERIFICATION DATA:

In order to process your application; please provide the following information.  Include your exact legal name and any other name(s) you may may have used in the last seven (07) years. 

First Name:
Last Name:
Current Address:
Apt #:
City:
State:
Zip Code:
Current Phone:
*(555-555-1212)
Date of Birth:
 (dd/mm/yyyy)
       
Other Name(s) Used:
From:
to (MM/DD)
Other Name(s) Used:
From:
to (MM/DD)

 

 PAST RESIDENCE DATA:

Applicants must provide city and state information for residence covering a period of seven (07) years.  Begin with your most current address.  If you are not sure of the address, include the city and zip.

City:
County:
State:
Zip Code:
From:
to (MM/DD)
City:
County:
State:
Zip Code:
From:
to (MM/DD)
City:
County:
State:
Zip Code:
From:
to (MM/DD)
City:
County:
State:
Zip Code:
From:
to (MM/DD)

 

 EMPLOYMENT REFERENCES:
First Name:
Last Name:
Previous Employer:
Employer Address:
Employer Phone:
*(555-555-1212)
City:
State:
Zip Code:

I have applied for employment with Accredited.  I authorize them to collect any information concerning my qualifications and past performance.  I authorize and request that you provide answers to the questions above.  I hereby release you from any and all liability in supplying any information regarding my employment with you.

DATE:
TYPE NAME TO SIGN:
First Name:
Last Name:
Previous Employer:
Employer Address:
Employer Phone:
*(555-555-1212)
City:
State:
Zip Code:
I have applied for employment with Accredited.  I authorize them to collect any information concerning my qualifications and past performance.  I authorize and request that you provide answers to the questions above.  I hereby release you from any and all liability in supplying any information regarding my employment with you.
DATE:
TYPE NAME TO SIGN:
First Name:
Last Name:
Previous Employer:
Employer Address:
Employer Phone:
*(555-555-1212)
City:
State:
Zip Code:
I have applied for employment with Accredited.  I authorize them to collect any information concerning my qualifications and past performance.  I authorize and request that you provide answers to the questions above.  I hereby release you from any and all liability in supplying any information regarding my employment with you.
DATE:
TYPE NAME TO SIGN:

 

 LICENSE NURSE - Competency Skills Checklist:

The following is a list of the skills required for effective home health care.  It is important that you can feel competent in these areas and can demonstrate expertise.  Any skills that you have never done or you feel you cannot perform accurately, should you be identified.  The procedure will be reviewed and learning experiences provided in those areas.  You will be checked off under "demonstrated performance" by a skilled home health care nurse following understanding of the procedure/skill.

Please check corresponding number pertaining to your work experience/competency level using the following scale:

1= Experienced, can perform without supervision
2= Capable, can perform/operate
3= Inexperienced with procedure/equipment; need supervision
 

Responsibility, Skill or Procedure

1

2

3
Handwashing
Body Mechanics
Vitale Signs
Bag Technique
CPR Certification
Assessment of Cardiopulmonary System
Patient with Pacemaker
Tracheotomy Care
Reinsertion of Tracheotomy Tube
Operating Suction Machine
Naso-oral Suctioning
Providing Percussion & Postural Drainage
Providing Pulmonary Treatments
Caring for Patients on Ventilator
Assessment & Intervention for Anaphylactic Shock
Inserting Oral Airway
Assessment of Gastrointestinal System
Insertion of NG Tube
NG Lavage
NG Gavage
Insertion of Gastrostomy Tube
Care of Gastrostomy Tube
Gastrostomy Feedings