HC Nursing
H & C Nursing Care Services — Employment Application (Online)Please complete all sections. You may upload your resume and required documents at the end.
Emergency Contact
License / Certification (if applicable)Provide up to 3 licenses/certifications.
Experience Information (No. of years)
If a resume is provided, you may exclude duplicate information below.
Education
Employment HistoryPlease provide your work history for the past five years.
Employer 1
Employer 2
Employer 3
References
Professional Reference 1
Professional Reference 2
Personal Reference 1
Personal Reference 2
Applicant Certification
I certify that my answers are true and complete to the best of my knowledge. I authorize H & C Nursing Care Service to make such investigation and inquiries of my personal employment, education, and financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools and individuals from all liability when responding to inquiries in connection with my application.
I understand that false or misleading information given in my application or interview(s) may result in discharge. I further understand that clients’ information is strictly confidential and can only be used for the reason it was collected.
Confidential Agreement
The nature of services provided by the Company requires information to be handled in a private, confidential manner. Information about our business, employees, or clients will only be released to people or agencies outside the company with written consent, except as required by legal or regulatory guidelines. All reports, memoranda, notes, or other documents will remain part of the company’s confidential records.
Hepatitis B Virus (HBV) Vaccination Consent
Due to occupational exposure to blood or other potentially infectious materials, you may be at risk of acquiring hepatitis B virus (HBV) infection. You have been informed of the importance of the hepatitis B vaccine. By declining this vaccine, you continue to be at risk of acquiring hepatitis B, which is a serious disease.
I understand it is my responsibility to obtain the three doses of the hepatitis B vaccine.
Workplace Acknowledgment
I understand that if I am not at my place of work (with my client) during my shift, it is considered patient’s negligence which may result in termination of duties. I also understand that at least a 30-day notification is required for employment separation.
After submission, our HR team will review your application and contact you if there’s a match.
Universal Precautions Quiz
Choose the best answer for multiple-choice questions and True/False for the remaining questions.
Registered Nurse (RN) Job Description
Please review the RN job description below and acknowledge.
TITLE OF POSITION: REGISTERED NURSE TITLE OF IMMEDIATE SUPERVISOR: Director of Nursing RISK OF EXPOSURE TO BLOODBORNE PATHOGENS - HIGH DUTIES To provide nursing care in accordance with the patient's plan of care to include comprehensive health and psychosocial evaluation, monitoring of the patient's condition, health promotion and prevention coordination of services, teaching and training activities and direct nursing care. RESPONSIBILITIES Coordinate total patient care by conducting comprehensive health and psychosocial evaluation, monitoring the patient's condition, promoting sound preventive practices, coordinating services and teaching and training activities. Evaluate the effectiveness of nursing service to the patient and family on an ongoing basis. Perform admission, transfer, re-certification, resumption of care and discharge OASIS for the home care patient. Prepare and present patient's record to the Clinical Record Review Committee as indicated. Consult with the attending physician concerning alterations of Patient Care Plans, checks with the appropriate supervisor and makes changes, as appropriate. Coordinate patient services. Submit clinical notes no less often than weekly, and progress notes and other clinical record forms outlining the services rendered as indicated. Submit a tally of patient care visits made each day. Participate in case conferences, discuss with the supervisor problems concerning the patients and how they may best be handled. Discuss with the appropriate supervisor the need for the involvement of other members of the health team such as the Home Health Aide, the Physical Therapist, the Speech Therapist, the Occupational Therapist, The Medical Social Worker, etc. Obtain orders for paraprofessional service and submits a referral to the appropriate personnel. Participate in the patient's discharge planning process. Cooperate with other agencies providing nursing or related services to provide continuity of care and to implement a comprehensive care plan. Participate in staff development meeting. Continually strive to improve his/her nursing care skills by attending in-service education, through formal education, attendance at workshops, conferences, active participation in professional and related organizations and individual research and reading. Participate in the development and periodic revision of the physician's Plan of Treatment and processes change orders as needed Submit clinical notes within seventy-two (72) hours, and progress notes and other clinical record forms outlining the services rendered. Participate in the patient's discharge planning process. Maintain an on-going knowledge of current drug therapy. Adhere to Federal, state and accreditation requirements including Medicare and Medicaid regulations. May be requested by Director of Nursing to fill in for the other nurses. COORDINATES THE ADMISSION OF A PATIENT TO THE AGENCY Conduct an initial and ongoing comprehensive assessment of the patient's needs, including Outcome and Assessment Information Set (OASIS) assessments at appropriate time points.
Pre-employment Questionnaire (Licensed Nurses Only)
Complete the questions below.
Required Documents Upload
Please upload clear photos/scans of the documents below.
Download forms:• W-4 Form: https://www.irs.gov/pub/irs-pdf/fw4.pdf• I-9 Form: https://www.uscis.gov/sites/default/files/document/forms/i-9-paper-version.pdf
If you do not have a required document available right now, you may submit the application and email missing items later if instructed.