* Required Information
REFERRAL SOURCE
AREAS WILLING TO WORK / TRAVEL
DAYS AVAILABLE FOR WORK
OFFICE USE

Unison Home Care is an equal opportunity employer. We adhere to policy of making employment decisions without regard to race, religion, color, national origin, sex, age, marital status, veteran status or disability.
PERSONAL INFORMATION
PLEASE ANSWER THE FOLLOWING QUESTIONS WITH YES OR NO
JOB INTEREST
EDUCATION
EMPLOYMENT HISTORY (Provide 5-year Work History)
PERSONAL AND PROFESSIONAL REFERENCES
ADDITIONAL INFORMATION
IN CASE OF EMERGENCY NOTIFY
I hereby certify that all statements made on this application is accurate and true, complete, and correct to the best of my knowledge and believe and realize that inclusion of false information or omission of material could result in DISMISAL of employment or REMOVAL of my application from further consideration. I also hereby certify that I am not suffering from a communicable diease or mental disorder which would hinder my job performance, nor have I been charged with or convicted of a crime involving abuse, neglect, exploitation, or deprivation of child or adult. I hereby authorize all my employers and police/sheriff dept. unless otherwise stated to release any and all information in regards to my employment as requested.

Please send me information on Unison Home Care .

If responding by mail send to: Attn: Human Resources 4273 Holliday Road, Atlanta, Georgia 30349

If responding by fax send to Attn: Human Resources1 770-216-1652 (Nurses and allied health personnel available locally and on traveling contracts to help meet your staffing requirements).
Unison Home Care EMPLOYEE POLICIES AND PROCEDURES
Every employee or independent contractor is expected to conduct themselves in a professional manner while in the client's home or workplace. You are depended upon to arrive at assigned client's home on time and in proper uniform. Once working, you are expected to provide quality patient care and or services according to your job classification and description. You must follow the policies and procedures of the Medicaid / Medicare program as well as Unison Home Care .
THE FOLLOWING IS GROUNDS FOR DISMISSAL AND MAY RESULT IN DISQUALIFICATION FOR UNEMPLOYMENT BENEFITS
All information about the client must be kept confidential (HIPPA policies and procedures must apply to all clients information).
An unusual amount of cancellations (2 (two) cancellations in 30 days called in after 4pm to on call manager.
A no-show for a previously confirmed shift (neglecting to call office to cancel shift) will result in 2 months suspension for booking shifts.
Habitual tardiness as reported by the client.
Failure to provide all required documentation (CPR, FIRST AIDE, TB certification completed IN-SERVICES) for personnel files.
Falsification of records or timesheets.
Client complaints caused by poor performance on an assignment.
Insubordination to administrative staff.
Non-compliance to OSHA/ Infection Control Standards or with Drug Free Workplace Policies.
Theft of client's property, borrowing money or other items from the client.
Sleeping while on an assignment, live —in cases need more clarification.
Illegal possession or attempting to take part in illegal sale and trafficking of illegal drugs or contraband.
Willful disregard for clients and Unison Home Care's policy.
Unauthorized removal of property belonging to client e.g. food, drinks etc.
Smoking in authorized areas.
Excessive use of cell phone or blue tube while in home while providing client care with excessive incoming and outgoing personal calls. (Cell phones are to be used for emergencies or communicating with the Unison Home Care office).
Spreading malicious rumors or gossip about co-workers, the clients, or Unison Home Care .
Leaving work early without contacting the staffing coordinator.
Employees can not accept any gifts or valuables without permission from Unison Home Care .
REQUIREMENTS FOR CONTINUED EMPLOYMENT WITH Unison Home Care
Report to work 15 minutes before the assigned time of arrival to the client's home.
Must attend orientation session and read orientation handbook .Arrangements regarding orientation will be made for the specific client assigned to work with.
All services are to be provided in accordance with the Private Home Care and CCSP/SOURCE/ ICWP Policies and Procedures.
You must call-in 24 hours prior to start of the assigned time to do the home visit, to ensure time enough for the client to be covered by a fill-in home care aide. On weekends, call-outs will be considered an incident of absenteeism. Unless explained by a doctor's note or a verifiable excuse.
Two absences with-in 30 days that was not pre-scheduled (or called in between the hours of 8am and 4 pm office hours) or called in less than 24 hours will result in a 2 (two) month suspension, for new assignments and removal from assigned clients unless accompanied by a verifiable excuse or doctor's note.
All employees are expected to maintain telephones and to keep communication open with the staffing coordinator.
Employees are required to work at least 1 (one) out of 30 (thirty) days to retain an active status, unless prior arrangement have been made with Unison Home Care .
It is the employee's responsibility to report all work related injuries to Unison Home Care . Immediately (within 24 hours). Failure to do so may waiver Unison Home Care's responsibilities making the employee responsible for the cost of needed care.
SIGNED BY NEW EMPLOYEES AND WITNESSED DURING EMPLOYMENT PROCESS

I have read and understand the above Policies and Procedures set by Unison Home Care , and by signing I agree to uphold these Policies and Procedures.

Unison Home Care PLEASE READ CAREFULLY.

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Unison Home Care . I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefits plans, policy statements, and the like as they might exist from time to time, or other Unison Home Care practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Unison Home Care or otherwise to change in any respect the employment-at will relationship between it and the undersigned, and may end the employment relationship at any time, without specific notice or reason. If employed, I understand that Unison Home Care may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
* I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give Unison Home Care permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release Unison Home Care from any liability as a result of such contract.
* I understand that (1) Unison Home Care has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of employment; and (3) continued employment is based on the successful passing of under such policy. I further understand that continued employment may be based on the successful passing of job related physical examinations.
* I understand that, in connection with the routine processing of my employment application, Unison Home Care will request a criminal background check and or an investigative consumer report including reported information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, Unison Home Care will provide me with additional information concerning the nature and scope of any such report requested by Unison Home Care , as requested by the Fair Credit Reporting Act.
* I further understand that my employment with Unison Home Care shall be probationary for a period of ninety (90) days and further that at any time during the probationary period or thereafter, my employment relation with Unison Home Care is terminable at will for any reason by either party.
Unison Home Care is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, or disability. We assure you that your opportunity for employment with Unison Home Care , depends solely on your qualifications.

Thank you for completing this application package and for your interest in our business.


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