Email info@ourhearthomecare.com
Call Call Today: 215-309-3885

Get Paid to Care your Loved Ones

We inspire hope and improve the quality of life for those entrusted to our care.

If you already work with another company to provide home care for your loved ones, please contact us to see if we can offer you a better incentive package.

“ Our Heart Home Care is a equal opportunity employer”

Thank you for your interest in working for our agency.

We're committed to building a positive and engaged work culture and providing opportunities for growth – including investing in our team members' futures with ongoing training and support. We are looking for talented, passionate people - Like HHA (Home Health Aids), Office Staff and Account Executives – Who can help us make a difference where it matters most, to our patients and their families.

We also Hire Eligible Family members and thier Friends to be the Caregivers for our LTSS waiver participants.

Please submit the application below to be considered for a position as a Caregiver.

Position Applied For * :

Personal Information
Last Name :
First Name :
Middle Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Home Phone :
Mobile Phone :
DOB :
Email * :

Emergency Contacts
In case of emergency contact:

Emergency Contact Name :
Emergency Contact Relationship :
Emergency Contact Phone :

Pre-Employment Questionnaire
1. Are you legally authorized to work in the United States? : Yes No
2. Will you now or in the future require sponsorship for employment visa status (e.g., F-1, H-1B, TN status)? : Yes No
3. Are you a preferred caregiver? (A person taking care of a family member/personal relative) : Yes No
4. Do you have any family members/personal relatives currently working for Our Heart Home Care Inc.? :
Yes No Please provide name :
5. Have you ever been convicted of a crime ? :
Yes No If yes, please explain :
6. Have you resided out of state in the past two years? : Yes No
7. Do you have any restrictions which would interfere with your ability to perform the essential duties of the position for which you have applied? :
Yes No Please explain :
8. Are you able to perform the tasks according to the job description without accommodation? : Yes No
9. If an accommodation is needed, how would perform the task and with what accommodation? :

Work Experience
List the work, military or volunteering experience below. Specify the 3 (three) most recent entries.

Experience 1

Employer's Name		 :
Street Address :
City :
State :
ZIP :
Phone :
Job Title :
Immediate Supervisor and Title :
Reason for Leaving :
Dates employed :
From : To :
Below Summarize the nature of work performed and job responsibilities :
Hourly Rates :
Start : Finish :
Salary :
Start : Finish :
May we contact for reference? : Yes No Later

Experience 2

Employer's Name		 :
Street Address :
City :
State :
ZIP :
Phone :
Job Title :
Immediate Supervisor and Title :
Reason for Leaving :
Dates employed :
From : To :
Below Summarize the nature of work performed and job responsibilities :
Hourly Rates :
Start : Finish :
Salary :
Start : Finish :
May we contact for reference? : Yes No Later

Education
List the educational experience below. Start with the highest or the most relevant to the position.

High School Diploma : Yes No
Education Institution 1 :
Program (Major) : Degree :
Education Institution 2 :
Program (Major) : Degree :

Licensure and Certification
Start by entering the most relevant licensure or certification. Do not list expired ones.
License & Certificate No. :
Issuing Organization :
License Date :
Issue Date : Expiration Date :
Nursing License No. :
Issuing Organization :
Name : State :
Nursing License Date :
Issue Date : Expiration Date :
Nursing Experience :
Total : Years. Homecare : Institutional Care :
Nurse Aide Certification No. :
Issuing Organization :
Name : State :
Nursing Aide Certification Date :
Issue Date : Expiration Date :
Whether Active :
Yes No Explain if not Active

Availability
Indicate the employment preferences, conditions and interests.

Date of Availability :
Days of the week you are available to work
( Check all that apply ) 		: Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Declaration :

By signing below, I declare that all information provided on my application to be a candidate for OHHC. or any information provided as attachment(s) to my application are true, accurate, and can be verified if necessary. I understand that any false statements or deliberate omissions on this document may be grounds for disqualification from employment or, if discovered after employment begins, could result in discipline up to and including my termination of employment.

By signing below, I certify and affirm that to the best of my knowledge and belief, I have not or have not had a case of abuse, neglect, mistreatment or exploitation substantiated against me. As a condition of submitting my application and in order to verify this affirmation, I hereby authorize OHHC to have full and complete access to any and all current or prior personnel or investigative records, from any party, person, business, entity or agency, whether governmental, or non-governmental, as pertains to any allegations against me of abuse, neglect, mistreatment or exploitation and to consider this information as may be deemed appropriate. I also authorize OHHC to run my criminal background and other clearances.

Last Name First Name Middle Initial

I hereby authorize Our Heart Home Care. to verify information provided on the employment application. Information subject to verification includes, but is not limited to: Former employment: dates of employment, main responsibilities, average of hours per week, supervising experience, quality of work performed, key strengths and areas for improvement, communication skills, reason for leaving organization and eligibility for rehire. Education, Licensure and Certification: Existence on registry, degree, GPA, expiration date.

Check this box and type in your name if you fully understand and agree to the terms above.

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law.

Active Type Expiration Date Notes
Photo ID
State ID
CPR Certification
First aide Certification
Professional License
PPD/Chest X-ray
Physical
State Criminal Background check
FBI background check
Child Abuse clearance
HHA Certification
Training

Additional Information
What do you like most about working with the elderly, disabled or convalescing? :
What do you find most challenging in this type of work? :
Are you available to work nights? :
Can you work on weekends? :
If you do not have a car how do you plan on getting to work? :
What is your Relationship to your emergency contact? :
Do you How many hours can you work in a week? :