Apply today online. Please submit your information using the form on this page. Employment ApplicationKaff Homecare, Inc. provides equal employment opportunities to all qualified persons and does not unlawfully discriminate against any person on the basis of race, color, creed, religion, sex, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Please: Complete all items on the application, even if the information is included on your resume or other document submitted by you. Sign and date your application. Specify the exact title of the position in which you are interested. Type or print all requested information. Provide three professional references. Attach resume (optional). POSITION APPLYING FOR *12/04/2024Personal InformationFirst Name *Middle NameLast Name *SOCIAL SECURITY NUMBER *DRIVER'S LICENSE (STATE/NUMBER)TELEPHONE NUMBER *ALTERNATE NUMBERSTREET ADDRESS *CITY *STATE *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP CODE *EMAIL ADDRESS *SELECT BELOW THE LANGUAGES YOU SPEAKEnglishFrenchIgboSpanishYoruba— OthersPlease type your language here *ATTACH RESUMEChoose FileNo file chosenDelete uploaded fileGeneral InformationARE YOU LEGALLY ELIGIBLE FOR WORK IN THE UNITED STATES? *YesNoIf yes, verification will be required.HAVE YOU EVER APPLIED TO OR WORKED FOR THIS KAFF HOMECARE, INC. BEFORE? *YesNoARE ANY OF YOUR RELATIVES CURRENTLY WORKING FOR KAFF HOMECARE, INC.? *YesNoHAVE YOU EVER BEEN CONVICTED OF A FELONY? *YesNoEmployment RequestMINIMUM SALARY REQUESTED *USDIF APPLICABLE, ARE YOU AVAILABLE FOR OVERTIME? *YesNoWHAT IS THE EARLIEST DATE YOU CAN BEGIN WORK? *HOW DID YOU HEAR ABOUT THIS POSITION? *RecruitedInternet Job PostingNewspaper ClassifiedCompany WebsiteOtherEmployment HistoryPlease begin with most recent employment.Employer 1EMPLOYER *MAY WE CONTACT YOUR CURRENT EMPLOYER? *YesNoNot ApplicableADDRESSSUPERVISORTELEPHONE NUMBERDATES OF EMPLOYMENT: FROMTOPOSITIONPAY OR SALARY – StartUSDPAY OR SALARY – FinalUSDDUTIESREASON FOR LEAVINGEmployer 2EMPLOYERMAY WE CONTACT YOUR CURRENT EMPLOYER?YesNoNot ApplicableADDRESSSUPERVISORTELEPHONE NUMBERDATES OF EMPLOYMENT: FROMTOPOSITIONPAY OR SALARY – StartUSDPAY OR SALARY – FinalUSDDUTIESREASON FOR LEAVINGEmployer 3EMPLOYERMAY WE CONTACT YOUR CURRENT EMPLOYER?YesNoNot ApplicableADDRESSSUPERVISORTELEPHONE NUMBERDATES OF EMPLOYMENT: FROMTOPOSITIONPAY OR SALARY – StartUSDPAY OR SALARY – FinalUSDDUTIESREASON FOR LEAVINGEmployer 4EMPLOYERMAY WE CONTACT YOUR CURRENT EMPLOYER?YesNoNot ApplicableSUPERVISORTELEPHONE NUMBERDATES OF EMPLOYMENT: FROMTOPOSITIONPAY OR SALARY – StartUSDPAY OR SALARY – FinalUSDDUTIESREASON FOR LEAVINGEducationHIGH SCHOOL/GEDLOCATIONCOURSE OF STUDYDEGREE OBTAINEDCOLLEGE/UNIVERSITYLOCATIONCOURSE OF STUDYDEGREE OBTAINEDGRADUATE SCHOOLLOCATIONCOURSE OF STUDYDEGREE OBTAINEDVOCATIONAL/SPECIALIZEDLOCATIONCOURSE OF STUDYDEGREE OBTAINEDMilitaryMILITARY SERVICEYesNoBRANCHSPECIALIZED TRAININGReferencesNAME *COMPANY *TITLE *CONTACT INFORMATION *NAME *COMPANY *TITLE *CONTACT INFORMATION *NAME *COMPANY *TITLE *CONTACT INFORMATION *Signature / CertificationI certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be ground for rejection of my application or, if this company employs me, for my immediate termination from employment. I authorize Kaff Homecare Inc. to make any necessary inquiries and investigations into my education, military, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to Kaff Homecare Inc. by any of the schools, services, or employers listed on this application.NAME OF APPLICANT *Date12/04/2024Please click to view and download the forms: Form I-9 Form W-4 Health Care Worker Background Check Form Upload Completed Form W-4Choose FileNo file chosenDelete uploaded filePre-Employment Background Check AuthorizationI, {name-1} , understand that as part of the employment process, need to complete a background check of me regarding: Criminal Record Sex and Violent Offenders Record; Employment Verification Education Verification License Verification Motor Vehicle Records Personal/Professional Reference Verification Medical Suitability Drugs/Alcohol I authorize all federal and state agencies, persons, and organizations that may have information relevant to this research to disclose such information to Kaff Homecare Inc. or its authorized agent(s).I understand that this authorization is to be part of the written and signed employment application.I also understand that I do not have to give authorization for a background check but if I don’t give permission, my employment application will not be processed further.I understand that I have specific rights under the federal Fair Credit Reporting Act (FCRA) and may have additional rights under relevant State law.I further authorize that a photocopy of this authorization may be considered as valid as the original.I hereby certify that all statements on this form are true and correct to the best of my knowledge and belief. I understand that employment with Kaff Homecare Inc. is contingent upon the successful completion of a background check.FULL NAMEDATE12/04/2024TELEPHONE NUMBERFORMER NAME(S) AND DATE(S) USEDCURRENT ADDRESSDATE OF BIRTHSOCIAL SECURITY NUMBERCURRENT DRIVER'S LICENSESTATESelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingList any other cities, states, and dates of residency during the last 10 years.CITYSTATESelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingFROMTOCITYSTATESelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingFROMTOCITYSTATESelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingFROMTOHome Care Companion Job DescriptionDescription: 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 inflictions. 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 providing the client has been assessed as being capable of ambulating without assistance; and/or, providing 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: The ability to be aware of other people’s reactions and understand why they react as they do. The ability to establish and maintain relationships. The ability to teach others. The ability to identify problems and determine effective solutions. The ability to apply reason and logic to identify strengths and weaknesses of possible solutions. The ability to understand written and oral instructions. The ability to communicate information orally and in writing. The ability to listen and understand the spoken word. The ability to work independently and in cooperation with others. The ability to determine or recognize when something is likely to go wrong. The ability to suggest a number of ideas on a subject. The ability to provide advice and consultation to others. The ability to observe and recognize changes in clients. The ability to 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. I have read and understood the job description and agree to fulfill the position’s responsibilities.EMPLOYEE NAME *DATE12/04/2024SUPERVISOR NAMEDATE Submit
