Home Care Assistants
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1 Home Care Assistants Wage & Benefits Home Care Assistants current starting rate: $14.10 to $15.80 depending on experience and certification. Live-in rate: $ Sleep over rate: $110 Benefits available at part time (med, dental, vision) Pension is available through the union. Accrual of paid time off: 1 hour paid time off for every 25 worked See how they love one another We believe every child should grow up in a safe, loving and nurturing environment. We believe the elderly should be able to live with security and dignity. We Believe healthy family life should be affirmed and supported in our communities. We believe in compassion, love and respect for all people, especially the poor and most vulnerable. We believe in joining with others to change systems that oppress, discriminate or otherwise cause human suffering. We believe employees and volunteers should work in an environment that fosters respect, teamwork and excellence. We believe in all of these things for all people, whatever their color, whatever language they speak or however they worship.
2 HOME CARE ASSISTANT JOB DESCRIPTION QUALIFICATIONS: Should be 18 years of age and have a minimum of one-year paid or unpaid experience in household management. Prior experience with elderly, and developmentally disabled, and/or handicapped persons preferred. The ability to communicate well, to maintain a neat appearance, and to work independently. Must be physically able to perform required tasks. Reliable transportation, valid Washington State Driver s License and automobile insurance are required. RESPONSIBILITIES: Perform tasks for clients as authorized on Client Data Sheet. These tasks may include: 1. Performing household chores to maintain normal standards of health and cleanliness 2. Preparing or assisting with preparation of meals, feeding and clean up (may include special diets) 3. Assisting clients with essential errands and shopping; clients are limited to one trip per week 4. Transporting and accompanying clients to medical services when client does not have personal transportation or is unable to go alone 5. Assisting clients with bathing, dressing, and personal care, (hair, teeth, dentures, shaving, and filing of nails) 6. Reminding clients to take self-administered medications 7. Assisting clients in and out of bed or wheelchair by providing support, steadying, and supervision 8. Completing and submitting all required reports and documentation, (i.e. Time/Mileage Reports, Leave slip, and Client Logs) 9. Reading and complying with all instructions contained in the Home Care Assistant Orientation Material and Personnel Policy Manual 10. Immediately reporting all accidents, incidents, and changes in the clients health or condition to a Home Care or Private Pay Supervisor
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7 LONG TERM CARE SYSTEM EMPLOYER REFERENCE CHECK has given you as a reference. We are considering employing this applicant as a Long Term Care Provider, who would provide caregiving assistance to the elderly and disabled in their homes. Since it is our policy to not employ anyone without completing a reference check, we would appreciate your assistance in responding to the below questions. I hereby release from all liability the company or person named below, and authorizes them to release all information regarding my employment with them. Applicant s Signature Person Contacted: Date Title/Position: Company Name: Employed From: To: 1. What are his/her primary job duties? 2. Please describe his/her job performance. a. Attendance b. Dependability c. Degree of supervision needed d. How did he/she get along with others? 3. Why did he/she leave your employment? 4. Would you re-employ? 5. How would you describe the applicant s ability to handle someone who is demanding or difficult? 6. To your knowledge, are there any limitations that would prevent this person from working effectively as a caregiver? 7. Would you feel comfortable with this person in your home providing these services? 8. (Ask only if the applicant worked for an agency or was an IP). Has the applicant completed required caregiver trainings? If not, were they ever discharged for not completing training? 9. Do you have any additional comments? Completed by Date 3cc (Rev.5/97 Retyped 02/08/00, Amended 1/23/2015)
8 SELF-IDENTIFICATION FORM Catholic Community Services is committed to non-discrimination, equal employment opportunity and affirmative action. This commitment is both a matter of law and a compassionate imperative in which individual differences and diversity are celebrated. Please Read carefully. The Information below is voluntary and is for statistical and affirmative action purposes. It will not be considered part of your official application for employment. Refusal to furnish this information shall have no adverse effects. Information, if given, will be maintained confidentially and separate from personnel files. Otherwise, the data will be released only as complied data in the aggregate and not related to an individual RACE/ETHNICITY: Check the box that is most applicable: NON-HISPANIC White (not Hispanic or Latino) Black or African American (not Hispanic or Latino) Asian (not Hispanic or Latino) American Indian or Alaskan Native (not Hispanic or Latino Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) Two or more races/ethnicities (not Hispanic or Latino) Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. Persons having origins in any of the black racial groups of Africa. Chinese/Chinese-American: Persons having origins in any of the original peoples of China. Japanese/Japanese-American: Persons having origins in any of the original peoples of Japan. Filipino/Pilipino: Persons having origins in any of the original peoples of the Philippine Islands. Pakistani/East Indian: Persons having origins in any of the original peoples of the Indian subcontinent (e.g., India and Pakistan). Other Asian: Persons having origins in any of the original peoples of the Far East (including Korea, Malaysia, Cambodia, Thailand and Vietnam), and Southeast Asia. Persons having origins in any of the original peoples of North and South America, (including Central American) and who maintains tribal affiliation or community attachment. Persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Persons who identify with more than one of the above races/ethnicities. HISPANIC OR LATINO Hispanic or Latino (including Black individuals whose origins are Hispanic) Mexican/Mexican-American/Chicano: Persons of Mexican culture or origin, regardless of race. Latin-American/Latino: Persons of Latin American (e.g., Central American, South American, Cuban, Puerto Rican) culture or origin, regardless of race. I choose not to self-identify. GENDER: Female Male I choose not to self-identify.
9 DISABILITY STATUS: Individual With Disability Status Code An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment. I choose not to self-identify. MILITARY SERVICE: Check all that apply: Check this box if you have ever served in the military. Vietnam-Era Veteran Status Code War/Campaign/Expedition Veteran Status Code Armed Forces Service Medal Veteran Disabled Veteran Status Code Recently Separated Veteran Vietnam-Era Veteran means a person who: Served on active duty for a period of more than 180 days, and was discharged or released there from with other than a dishonorable discharge, if any part of such active duty occurred: a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5,1964, and May 7, 1975, in all other cases; or Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases. A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized Armed Forces Service Medal Veteran means: A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty. A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or A person who was discharged or released from active duty because of a service-connected disability Any veteran during the three-year period beginning on date of such veteran s discharge or release from active duty in the U. S. military, ground, naval or air service. I choose not to self-identify. I certify that this information is true and accurate to the best of my knowledge. Signature: Date:
10 OFFICE USE ONLY LONG TERM CARE SYSTEM EMPLOYMENT APPLICATION INSERT PAGE Hire Date: Term Date: Ck. P.A. Yes No CNA Tmd Yes No Name of Applicant: Last First Middle Are you at least 18 years of age? Yes No Available work hours: Check appropriate boxes and list available work hours. Available hours: Part-time Full-time Overnight Short term live in (3 or less 24-hour periods in a week) Long term live in (4 or more 24-hour periods in a week) Available Locations: If you have any previous experience providing the type of care required by this position (family, volunteer, or paid) and have not listed it on your CCS Employment Application, please provide the details below. Provide the names, telephone number, and types of assistance you provide. Have you had experience in the following areas? Housework Cooking Special Diet Shopping Assist with: wheelchair/bed transfer Yes No Walking Assistance* Bathing Assistance* Personal Grooming* Child and/or Baby Care Care of Elderly Care of Disabled Yes No (with individuals 13 years of age or older) 30cc (Retyped 09/29/17)
11 Thank you for your interest in our Home Care Assistant positions. Our Home Care team provides excellent basic care for the elderly and developmentally disabled. A full job description is included in this application packet. Please complete the following application materials, including CCSWW application and self id, HCA application insert and advertising form. Upon completion, submit your application via to office associated with the area where you would like to work. Office and Address Contact name Service Area Aberdeen 218 S. M Street Aberdeen, WA Ashley Hayes Jobs-ltcpa@ccsww.org Grays Harbor County Jeana Couchman Lisa Gunn Shirley Pruett Jobsltcbellingham@ccsww.org Jobsltckitsapmason@ccsww.org Jobsltclewisthurston@ccsww.org Whatcom and Skagit Counties Kitsap County Lewis County Jeana Couchman Jobs-ltceverett@ccsww.org Snohomish County Annie Skinner jobsltckingco@ccsww.org King County Edith Nayiga jobs-ltcpierce@ccsww.org Pierce County Jacquelene Wimbs Shirley Pruett Cowlitz County Thurston County Ashley Hayes Jobs-ltcpa@ccsww.org Clallam and Jefferson Counties Lisa Gunn Mason County Edith Nayiga Jobs-ltcpierce@ccsww.org Pierce County Jacquelene Wimbs Bellingham 1742 Iowa St Bellingham, WA Bremerton th St Ste 3 Bremerton, WA Chehalis 1570 No National Ave Ste 211 Chehalis, WA Everett 1001 N Broadway Ste A- 12 Everett, WA Kent 835 N Central Ave #D 113 Kent, WA Lakewood 5705 Main St SW Lakewood, WA Longview 923 Fir St Longview, WA Olympia 129 Decatur St NW Olympia, WA Port Angeles 701 E Front St PORT Angeles, WA Shelton 1716 Olympic Hwy N Shelton, WA Tacoma 1323 S Yakima Ave PO Box 1235 Tacoma, WA Vancouver 5411 E Mill Plain Blvd #22 Vancouver, WA Jobsltcvanclong@ccsww.org Jobsltclewisthurston@ccsww.org Jobsltckitsapmason@ccsww.org Jobsltcvanclong@ccsww.org Clark and Skamania Counties
12 Dear Applicant, Thank you for applying for employment with the Long Term Care System of Catholic Community Services of Western Washington. We would appreciate it very much if you would help us ensure that our help wanted advertising is effective by filling out this form and turning it in with your application. Please check where you heard of our program or this job opening. Please be as specific as possible. [ ] Employment Security Department Location [ ] Newspaper Advertisement- Name [ ] Website: [ ] Craig s List [ ] CNA.Com [ ] Indeed.com [ ] Monster.com [ ] CareerBuilders.com [ ] Other [ ] Social Media: [ ] Facebook [ ] LinkedIn [ ] Other [ ] College/University [ ] Church Name [ ] Club/Organization Name [ ] Friend or Family member [ ] Walk-in (Banner) [ ] Referred by CCS employee. Please tell us who referred you; we would like to thank them. [ ] Other source not listed here Was the following helpful in the advertisement that you saw? (Please check) Wage Information [ ] yes [ ] no [ ] Information not in ad Benefit Information [ ] yes [ ] no [ ] Information not in ad Details about Job [ ] yes [ ] no [ ] Information not in ad Other What made you notice our advertisement and decide to apply here?
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