Interview Checklist Interview Checklist Name of Applicant: Position being applied for: Date MM slash DD slash YYYY Review of Job description Review of requirements Review of application Review of education and experience Review of shifts checklist Review of required testing Availability days, times and serviceareas Comments: Signature/Title of Interviewer:Date MM slash DD slash YYYY We are an equal opportunity employer Pre-hire InterviewInterview conducted by Date MM slash DD slash YYYY Date of inquiry: MM slash DD slash YYYY Name of interested caller: Address Street Address City State / Province / Region ZIP / Postal Code PhoneEmail Requesting info on which position If PCW, do they have training? Has caller ever wormed in home care? If yes, where If Companion do they have any proof of work in that capacity? Has caller ever worked in home care? If yes, where Is caller currently working anywhere? If yes, where Would caller be interested in per diem work with us? yes, when could they be available to do orientation? Our pay rate is $/hour for Respiteand $for PCAand $ /hour for Companion.Ae these rates acceptable? Yes No Our policy is that we cannot hire convicted felons. Would anything be likely to show up on their criminal history to prevent us from hiring? Orientation is a 4-hour session for all employees. Direct care staff have an additional 4 hours of orientation. If the above is agreeable to both agency and the caller, please ash the caller to come in to fi11 out an application and criminal history form. They will be called for orientation scheduling once the approved criminal history results come baclr from the State.Name Date MM slash DD slash YYYY liberty Home Care New Hire Questions1. In your opinion, tell me what makes you a good caregiver [or why you thini‹ you will be a good caregivers. 2. Tell me about some personal goals or work-related you have and what you are doing to accomplish them. 3. What aspects of the job do you find most likely to wear you down or discourage you? 4. What do you do to motivate yo urself to work hard during times when you feel lacl‹ing in motivation? 5. What is the biggest challenge for you when working as a caregiver [or what do you think it will be], and what have you done about it/what are you going to do about It? 6. Tell me what makes you most excited working with seniors. 7. Tell me about your level of experience working with seniors so far. 8. Why did you leave your last job? 9. How much experience do you have working with clients with Alzheimer's, Dementia, Depression and Out there behavior]. What challenges have you experienced while working with these clients and what did you do to overcome these challenges? 10. Tell me about a time when you cared for a senior. What part of the experience Was most difficult and what: was most meaningful to you? 11. Tell me about a time when you worked with a difficult client [or customer]. What made it difficult to work with them and what did you do to resolve the issue and help them? 12. Describe for me how the experiehce in your resume has helped you build the skills necessary to be a good caregiver. 13. Imagine that you're finding a caregiver for one of your loved ones. What traits or skills would be most important to you for this caregiver to have? 14. If you were hiring Someone for this position, what are the top three skilIs or traits that you would Iook for? 15. In what skills area do you feel most qualified to be a caregiver and in what area of skill do you feel the least qualified to be a caregiver? 16. if a client of yours refused to [take a shower, eat a meal, go to the bathroom, doctors, etc.], how would you deal with the situation? 17. How would you handle the situation if a work supervisor reprimanded you and you felt that it was unjustified or unfair? 18. Describe a circumstance in which you believe it would be justified to be late for work. 19. How would you respond to a client Who used rude or derogatory language toward you? 20. Imagine that you decide you need in home care for yourself. Describe the kind of caregiver you would want. How well do you think you meet this criteria as a caregiver? 21. If you are hired here, what will you do on your own initiative to make yourself the best employee you can be? 22. What type of rewards or recognition from your employer best motivate you? 23. What are the three factors most likely to persuade you to stay at a job long term? 24. What factor test motivates you to give your all to a job? 25. If you were to get the job, what kind of training could we provide that would help to make you a better caregiver? 26. Any questions, comment or concerns for us that we could ease any nerves? Employment Offer Letter Date MM slash DD slash YYYY RE: JOB OFFER FOR I am pleased to offer you a position as with Liberty Home Care.You will begin your full-time, part-time, per diem, or salary (Circle one) position on MM slash DD slash YYYY Your employment location is in as identified below:You will report directly to the Agency Director of your office for all administrative and operational purposes.Your salary offer for this position is $per year per hour per visit (Circle one)Benefits are not currently offered as we are a startup agency. We will notify you immediately when we are prepared to begin offering a benefit package consult your employee handbook or the Agency Director for other benefit information.Sincerely, Agency Director Offer accepted by:Employee SignatureDate MM slash DD slash YYYY Availability ListEMPLOYEE NAME: Phone#Cell phone#Iam available at the following days and / or hours:Mon From To Tue From To Weds From To Thurs From To Fri From To sat From To sun From To ONLY list towns you are willing to travel to.Employee Direct Deposit Authorization Instructions Employee: Fill out and return to your employer. Employer: Save for your files only. This document must be signed by employees requesting automatic deposit of paychecks and retained on file by the employer. Do not send this form to intuit. Employees must attach a voided check for each of their accounts to help verify their account numbers and banks routing numbers.Account 1 Account 1 type: Checking Savings Bank routing number (ABA number): Account number: Percentage or dollar amount to be deposited to this account Account 2 type: Checking Savings Bank routing number (ABA number): Account number: attach a voided check for each account hereMax. file size: 100 MB.Authorization (enter your company name in the blame space below) This authorizes (the "Company”) to send credit entries(and appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify in the future (the "Account").This authorise the financial institution holding the Account to post all such entries. I agree that the ACH transaction authorized herein shall comply with all applicable U.S. Law. This authorization we be in effect until the company receives a written termination notice from and had a reasonable opportunity to act on it. Authorized signature:Employee ID #: Print Name Date MM slash DD slash YYYY Documents Needed Format On day of completing application, the hiring Staff MUST process Criminal Background checks. Must be in the employee's file before 1" visit is scheduled. You must do an online check (Professionals) for license in good standing. Print the verification page out for employee file. Proof of car insurance (registration showing insured status) if applicable TB Test Results Identification: Driver‘ s license (current) 2nd form of identification Current copy of professional license Training certificate (if applies) Social Security card Criminal Check returned Immigration documents in order (if applicable) ChildLine Verification (18 years of age) (If applicable) Tests to be completed with a passing score of 80% HIPAA Shifts Competency Checklist to be completed on or before 1" Consumers visit Skills checklist done
