Employment Application

Please begin with your most recent employment.

Authorization and Disclosure for Criminal History Records Information (CHRI) Check

State of Illinois (Illinois Department of Public Health)

I hereby authorize the Illinois Department of Public Health (the Department), the Department's designee, educational entities that train and/or test health care workers, staffing agencies, my current or potential employer, or a health care facility where I want to volunteer to initiate/request a CHRI check on me. I further authorize the Illinois State Police (ISP) and/or the Federal Bureau of Investigation (FBI) to release information relative to the existence or nonexistence of any criminal record which it might have concerning me, to any initiator/requestor solely to determine my suitability for training or testing in a health care training program, employment, continued employment, or to work as a volunteer. I further authorize any entity that maintains criminal records relating to me, including but not limited to a local unit of government in any State, to release those records to the ISP, FBI, or the Department. I authorize the Department to provide any health care facility, training program or staffing agency to which I have provided this authorization and disclosure form a copy of my ISP CHRI and a determination of eligibility of the FBI CHRI. I certify that the ISP, FBI, any entity that maintains criminal records, the Department, and any of their employees or officers who furnish this information shall be held harmless from all liability which may be incurred as a result of releasing such information. I further acknowledge that an educational entity or health care employer shall not be liable for the failure to hire or retain me as an applicant, student, employee, or volunteer if I have been convicted of committing or attempting to commit one or more of the offenses stated in the Health Care Worker Background Check Act (225 ILCS 46/25).

I understand that any false statements or deliberate omissions on this document may be grounds for disqualification from employment, training, or volunteering; if discovered after employment, training, or volunteering begins, they can result in discipline up to and including my termination.

I understand that the information requested below regarding gender, race, height, eye color, hair color, weight, place of birth and date of birth is for the sole purpose of identification and the accurate gathering of criminal history record information, and that it will not be used to discriminate against me in violation of the law. I understand that the provision of my Social Security number is required by law. A facsimile or photographic copy of this authorization will be as valid as the original.

Description

Home Care Companions provide service to individuals in their own homes and communities who need assistance caring for themselves as a result of old age, sickness, disability, and/or other afflictions. Home care may include light housecleaning, laundry, meal preparation, transportation, companionship, respite, and advice on such things as nutrition, cleanliness, and household activities. Home Care Companions are responsible for ensuring that service is delivered in a caring and respectful manner, in accordance with relevant Agency policies and industry standards.

Reporting Relationship

Reports to Supervisor.

Responsibilities / Activities

• Provide companionship, friendship, and emotional support.
• Talk, listen, share experiences, play games/cards, read to clients, etc.
• Help keep clients in contact with family, friends, and the outside world.
• Provide transportation to medical appointments, grocery stores, and errands.
• Accompany clients to recreational and/or social events.
• Assist with plans for visits and outings.
• Write or type letters/correspondence; organize and read mail.
• Plan trips and outings and possibly travel with clients.
• Teach/perform meal planning and preparation.
• Perform light housekeeping.
• Participate in the Care Team by providing input and making suggestions.
• Ensure service is delivered in accordance with Agency policies, procedures, and industry standards.
• Monitor supplies and resources.
• Evaluate the program and make recommendations, as indicated. Follow the written care plan.
• Assist in basic client transfers, provided the client has been assessed as capable of ambulating without assistance, and/or another trained caregiver (including family) is involved in the transfer.
• Carry out duties as assigned by the Supervisor.
• Observe the client's functioning and report to Supervisor.
• Complete and maintain records of daily activities, observations, and direct hours of service.
• Develop and maintain constructive and cooperative working relationships with others.
• Make decisions and solve problems.
• Assist with pet care.
• Communicate with Supervisor and co-workers.
• Attend orientation, in-service training sessions, and staff meetings.

Required Knowledge

• Knowledge of home management skills.
• Knowledge of principles and processes for providing client services, including needs determinants, meeting quality standards, and evaluation of client satisfaction.
• Knowledge of the English language.
• Knowledge of information and techniques needed to diagnose and treat injuries including emergency first aid and CPR.
• Knowledge of clerical procedures such as maintaining records and completing forms.

Required Skills / Abilities

• Be aware of other people's reactions and understand why they react as they do.
• Establish and maintain relationships.
• Teach others.
• Identify problems and determine effective solutions.
• Apply reason and logic to identify strengths and weaknesses of possible solutions.
• Understand written and oral instructions.
• Communicate information orally and in writing; listen and understand the spoken word.
• Work independently and in cooperation with others.
• Determine or recognize when something is likely to go wrong.
• Suggest a number of ideas on a subject.
• Provide advice and consultation to others.
• Observe and recognize changes in clients.
• Establish and maintain harmonious relations with clients/families/co-workers.

Physical and Mental Demands

• Good physical and mental health.
• Physical ability to stand, walk, use hands and fingers, reach, stoop, kneel, crouch, talk, hear and see.
• Mental fortitude and stability to handle stress.
• Physical and mental ability to drive a vehicle.

Qualifications / Education

• High school diploma.
• Current driver's license.
• Proper Vehicle Insurance Coverage.

Training / Experience

• May require related experience.
• May require similar social and cultural backgrounds with some clients.