Pasadena Home Health Care, Inc. is open to applicants who are dedicated to serving our clients. Our team of professionals keeps on growing as a whole and improving in many aspects of the health care field. Apply now by filling out the form provided below.

APPLICATION FOR EMPLOYMENT

    Date of Application:
    Adress
    SS.#
    Date of Birth
    Days available for work:
    Do you Drive?
    Do you have a car?
    Are you presently employed?
    May we contact your current employer?
    Do you have the necessary Visa or immigration Statues to work legally in U.S.?
    Have you ever been injured on the job?
    Have you filed a worker's compensations case?
    Have you been convicted of a felony?
    (Conviction will not necessarily disqualify an applicant from employment)
    Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non job related medical condition or handicap.

    AN EQUAL OPPORTUNITY EMPLOYER

    Please provide the following
    I understand that I must keep these active and valid promptly notify PASADENA HOME HEALTH CARE of any changes.
    Professional License
    CPR Card
    Professional Liability Insurance
    DMV Driving Record
    Chest / TB
    Physical Examination
    Automobile Insurance
    Employee Signature:
    Date:

    APPLICANT'S STATEMENT

    I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at a employment decision.

    I understand that this application is not and is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given in my application or interview/s may result in discharge. I understand, also, that I am required to abide all rules and regulations of PASADENA HOME HEALTH CARE.
    Employee Signature:
    Date:

    FOR OFFICE USE ONLY

    Arrange Interview:
    Employed
    employment-date
    Job title
    Rate
    By
    Date

    CONFIDENTIALITY POLICY

    PASADENA HOME HEALTH CARE endorses the ANA code for nurses reflecting:
    "The nurse safeguards the patient's/client's rights to privacy by judiciously protecting information of a confidential nature".

    I agree to safeguard and protect the privacy of all patients/clients I come in contact with.

    In particular I will:
    • Divulge no information of a confidential nature on any patient's/client's.
    • Review Patient's/Client's charts only when necessary to insure care.
    Employee Signature:
    Date:

    EMPLOYEE ACKNOWLEDGMENT OF STANDARDS, POLICIES AND JOB DESCRIPTION

    I, the undersigned hereby acknowledge receipt of orientation to the Employee Standards and policies of the Company.

    I likewise acknowledge to honor, and will abide the policies of PASADENA HOME HEALTH CARE and any other material as required and directed to comply with the standards of the Joint Commission on the Accreditation of Hospitals and Tile XXII. I realize that violation may result in disciplinary action up to and including termination.

    I have also read and understand my job description.
    Employee Signature:
    Date:

    EMPLOYEE-EMPLOYER AGREEMENT

    In compliance with the policies of PASADENA HOME HEALTH CARE I, the undersigned hereby agree that my payroll check may be withheld until I submitted my professional and educational requirements as directed by the regulatory agencies.
    Employee Signature:
    Date:

    EMPLOYMENT EXPERIENCE

    Start with your present or last job. Include military assignment and volunteer activities.
    Exclude organization names indicative of race, religion, color, sex or national origin.
    Employer Telephone
    Employment From
    To:
    Job Title/Work Performed
    Adress
    Employer Telephone
    Employment From
    To:
    Job Title/Work Performed
    Adress
    Employer Telephone
    Employment From
    To:
    Job Title/Work Performed
    Adress
    Please indicate the number of years experience:

    PAY RATES QUOTE

    It has been understood that I have been notified of my pay rate in accordance with my classification, experience, specialty and shift choice.
    Shift Choice
    Rate Quoted
    Agency Representative Signature:
    Date:

    PAYCHECK DISBURSEMENT INFORMATION

    Employee Signature:
    Date:
    I, the undersigned, request my paycheck to be held in the office for pick-up.
    Employee Signature:
    Date:

    Special Skills and Qualifications.

    Indicate the Languages you speak, read and / or write besides English.

    Incase of an Emergency, who is the person you wish to be notified?

    Give names, addresses and telephone numbers of three references who are not related to you and are not previous employers.

    High School Name & Address
    Year Graduated
    Diploma/Degree
    College/University
    Year Graduated
    Diploma/Degree
    Post Graduate
    Year Graduated
    Diploma/Degree
    Describe Specialized Training, Apprenticeship, Skills and Extra-Curricular Activities & Honors received.