LPN - Compassionate Home Health Care, Inc

GET PAID TO TAKE CARE OF A FAMILY MEMBER

(724) 965-8355 info@mychhcare.com

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LPN

Position Applied For

PERSONAL INFORMATION

First Name

Middle Initial

Last Name

Address

Home Phone

Cell Phone

Email

Are you at least 18?

Yes

No

Are you a US Citizen?

Yes

No

Legally Eligible to work in USA?

Yes

No

Convicted of a Felony or Misdemeanor

Yes

No

If yes, what was the charge?

Nursing License(s)

PA

Ohio

Ohio & PA

Lived outside Pennsylvania in past 5 years?

Yes

No

If yes, where?

List any previous last names

"Month" you were born

"Day" of the month you were born

Social Security Number (secure)

Next

JOB SPECIFIC INFORMATION

Reliable Vehicle?

Yes

No

Current Vehicle Insurance

Yes

No

Preferred Shift (1st)

Preferred Shift (2nd)

Days Available to Work

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Start Time

End Time

Hours Requested per Week

Will you be working another job?

Yes

No

How many hours per week?

Do you attend school?

Yes

No

Total School Hours per Week

Where did you hear about us?

CHHC employees you may know

Own a Smartphone or Tablet?

Yes

No

Is it an android of iphone model?

Android

iPhone

Other

Available Start Date

Areas willing to travel to

Tell us something NICE about yourself

Is there anything else we need to know?

Next

EMPLOYER 1

Company Name

Address

Phone Number

Start Date

End Date

Position Held

Hourly Wage

Supervisor's Name

Reason for Leaving

Did you give a 2 week notice?

Yes

No

May we contact?

Yes

No

Section Buttons

Next

EMPLOYER 2

Company Name

Address

Phone Number

Start Date

End Date

Position Held

Hourly Wage

Supervisor's Name

Reason for Leaving

Did you give a 2 week notice?

Yes

No

May we contact?

Yes

No

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EMPLOYER 3

Company Name

Address

Phone Number

Start Date

End Date

Position Held

Hourly Wage

Supervisor's Name

Reason for Leaving

Did you give a 2 week notice?

Yes

No

May we contact?

Yes

No

Section Buttons

Next

MANDATORY REQUIREMENTS

High School

City

State

Nursing School Attended

City

State

License Number

License Issue Date

License Expiration Date

CPR Issue Date

CPR Expiration Date

Driver's License Number

Driver's License Issue Date

Driver's License Expiration Date

Section Buttons

Next

SKILL COMFORT LEVEL

Point of Care Software

Tablet Use

Telephony

Electronic Visit Verification System (EVVS)

Enteral Tube Medication Administration

Identifying Breath Sounds

Use and Care of Oxygen

Nebulizer/Aerosol Therapy

Tracheostomy Care/Suctioning

Home Ventilator BiPAP/CPAP

Pulse Oximetry

Apnea Monitor

Gastric Tube Insertion (GT, Mic-Key Button)

Gastrostomy Care

Colostomy Stoma Care

Foley/Suprapubic Catheter Care

Glucometers (Use, Care & Technique)

Enteral Feeding Pumps

Experience with Alzheimer's and Dementia

Injections - IM, SQ, ID

Wound Care

IV Therapy

Cardiopulmonary Assessment

Aseptic Technique

Universal Precautions

Personal Protective Equipment

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Attach Resume

Compassionate Home Health Care, Inc

2305 Wilmington Rd., Suite #3
New Castle, PA 16105

Phone



Email

info@mychhcare.com

Service Areas

Allegheny
Beaver
Butler
Crawford
Lawrence
Mercer
Venango

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