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Illinois Employment Application

Home/Illinois Employment Application
Illinois Employment Applicationnancy@zw2.com2021-11-26T15:01:04-06:00

Step 1 of 19 - General Information

5%
Name(Required)
How did you hear about us?
Are you applying to work for a specific client?
Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Applicant Information


Enter your complete address on the appropriate lines below:(Required)
Please enter "none" if this does not apply.
Have you previously been employed by this company or it’s affiliates? *(Required)
Please enter a numeric hourly value with no dollar sign.
If employed will you be able to submit verification, including a photo ID, of your legal right to work in the U.S.?(Required)
Does the name used to apply match the name on your ID and social security card?(Required)
Do you have reliable transportation?(Required)
Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Diversity Questionnaire



The Equal Employment Opportunity Commission (EEOC) requires this organization to report its employees’ gender and race in order to complete an EEO-1 report each year. Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only.
Gender
Race / Ethnicity
Please select one of the descriptions below which identify you.
Hispanic or Latino
White (Not Hispanic or Latino)
Black or African American (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
Asian (Not Hispanic or Latino)
American Indian or Alaska Native (Not Hispanic or Latino)
Two or More Races (Not Hispanic or Latino)
Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Communication Preferences:

How would you prefer that we contact you:(Required)

Your application can be started now but to fully complete this application, you will need to upload the following documents where prompted:

  • High school diploma or equivalent (for Illinois applicants only)
  • Voided check
  • Valid drivers license or photo ID
  • Proof of auto insurance (for Illinois applicants only)
  • Social Security card
Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Skills and Qualifications


Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Work Availability


MM slash DD slash YYYY
Are you able to work weekends?(Required)
Are you available to work overnight?(Required)
Which days of the week are you available to work?(Required)
Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Emergency Contacts


Please enter at least one emergency contact.

Emergency Contact 1 Name(Required)
Emergency Contact 2 Name
Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Transportation


Advantage In-Home Services requires you to show proof of a valid driver’s license and car insurance if you elect to operate a vehicle.  If you are not able to show proof of these things, you are not allowed to drive and it is expected that you take public transit.

Do you plan on driving a vehicle to and from work and potentially during working hours for things like shopping, errands and transportation for your client? 

Prior to operating a vehicle to and from work and/or during working hours, certain credentials must be met and Advantage In-Home Services must approve these services.

Completion of this section does not qualify as approval.  You must receive verbal approval from a supervisor prior to providing shopping and errands or transportation services.

In order to qualify and be approved to provide these services you must have:

You will be required to upload a copy of your drivers license and car insurance on the uploads page. NOTE: YOU WILL ALSO BE REQUIRED TO UPLOAD ADDITIONAL VEHICLE DOCUMENTS ON THE UPLOADS PAGE.

Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Qualifications for Hire:


I am at least 18 years of age(Required)
Sorry you are not eligible for hire.
I am able to read, write and follow directions:(Required)
Sorry you are not eligible for hire.
I meet at least one of the following qualifications. (Check all that apply):
Sorry you are not eligible for hire.
Are you being hired to take care of a family member: 
Family Home Care Aide Policy
Family Care Aide Policy
Advantage In-Home Services Family Home Care Aide Policy

Under no circumstances can a family member be hired as a Home Care Aide if the family member is a legally responsible person to the applicant/participant (spouse, guardian, person(s) with POA and representative payees)

Advantage In-Home Services will determine if the family home care aide will be appropriate for the
postiion as home care aide for the client.

Family Home Care Aides must meet all applicable requirements and there are no exceptions.

All family home care aide’s must possess the appropriate skills requried to complete the tasks that are on the client’s care plan.

The family home care aide cannot sign any of the client’s forms at any time. If it is found that the family home care aide signed the client’s forms, they will be removed as the family home care aide.

The family home care aide cannot serve as the interpretor during client reassessments

Advantage In-Home Services will conduct monthly phone calls during the scheduled hours of service to ensure the family home care aide is present and is accurately reporting hours worked.

Unnounnced home visits will be conducted at random times by the supervisor to ensure the family home care aide is following the care plan and monitoring the client’s health/status
Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

Education


Years of High School completed:(Required)
State of your High School
Did you graduate?(Required)
Drop files here or
Accepted file types: jpg, pdf, Max. file size: 450 MB.
    Please upload this here. This can also be loaded at a different time.


    Years of College or Vocational Program:
    State of your College or Vocational Program
    Did you graduate?
    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Employment History


    Provide details of your past and current employers starting with the most recent. Please be sure to include any experience in the health care field and any experience caring for the sick, aged, disabled or a child. We are required to obtain 2 references on all applicants so please complete at least two employers if applicable to you.
    MM slash DD slash YYYY
    Employer 1 - Are you still employed here?
    MM slash DD slash YYYY
    Employer 1 Address(Required)
    Employer 1 - Can Advantage contact this employer to obtain a job reference?(Required)


    MM slash DD slash YYYY
    Employer 2 - Are you still employed here?
    MM slash DD slash YYYY
    Employer 2 Address
    Employer 2 - Can Advantage contact this employer to obtain a job reference?


    MM slash DD slash YYYY
    Employer 3 - Are you still employed here?
    MM slash DD slash YYYY
    Employer 3 Address
    Employer 3 - Can Advantage contact this employer to obtain a job reference?
    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Unpaid Experience or Personal References


    In order to be eligible for hire, you must prove that you have employment experience working as a homemaker/aide/nurse OR that you have paid or unpaid experience caring for children, the elderly or the sick. If we are unable to verify your experience through an employer listed in the last section of this application, then we will need to verify your experience through a personal reference or volunteer activities.

    Please provide us with who we can contact to verify your experience.

    Reference 1 - Can Advantage contact this person to verify your experience?(Required)


    Reference 2 - Can Advantage contact this person to verify your experience?


    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Background Checks


    Advantage In- Home Services, LLC is required by law to run background checks prior to hire. Please refer to the Background Policy and authorization at the end of this application for more details.

    I will allow Advantage In-Home Services, LLC to run the required background checks on me in order to confirm I am eligible for hire.(Required)
    Sorry you are not eligible for hire.
    Please check one of the following statements that apply to you:(Required)
    What dates did you live outside of Illinois?(Required)
    From Date
    To Date
     
    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Health Statement


    Advantage In-Home Services is responsible for ensuring and documenting that the health of each employee allows them to perform their assigned job duties adequately, safely and poses no risk or hazards to the client or other employees they may come into contact with. It is our expectation that the following health statement be completed truthfully.

    Do you have any concerns about your ability to physically perform home care functions without assistance?(Required)
    Do you currently have any restrictions at work as signed off by your physician?(Required)
    Have you ever had a back injury, chronic back pain or hernia?(Required)
    Are you able to spend up to 8 hours on your feet at a time?(Required)
    Do you feel you are able to push/pull a patient at a minimum of 100 pounds?(Required)
    Do you feel that if you had to in an emergency, you would be able to lift 50 pounds?(Required)
    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Communicable Disease Statement


    It is the policy of Advantage In-Home Services that all employees be free of communicable diseases while working. It is our expectation that the Communicable Disease Statement be completed truthfully. Having a communicable disease does not disqualify you from employment however you will be required to be free of communicable disease before you can report to work. A communicable disease is one that is spread from one person to another through a variety of ways that include contact with blood and bodily fluids, breathing in an airborne virus, etc.

    Are you currently free of communicable disease?(Required)
    (If your answer is no, it does not disqualify you from being hired however you will have to wait until you are free of communicable disease in order to report to work.)
    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Errands and Transportation


    At times, a home care client may have shopping and errands on their care plan. This means that the caregiver will be asked to leave the client’s home for a short time during their shift (usually once a week) to run essential errands on behalf of the client. These errands should be as close to the client’s home as possible to places like the grocery store, drug store, hardware store, etc. The caregiver is NOT allowed to drive the client’s car and the client is not allowed to ride with the caregiver. (*Some funder sources do allow for other transportation situations BUT this needs prior approval and a separate policy and screening protocols are in place*)

    Are you willing to run essential errands on behalf of your client?
    Will you be driving in your personal car or taking public transit?(Required)
    Do you have a valid drivers license?(Required)

    You are not allowed to drive a vehicle during working hours without a valid driver’s license and car insurance as required by law. 

    Do you have auto insurance?

    If no, you are not eligible to use your personal vehicle during working hours.

    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Hepatitis B Vaccination


    Due to the occupational risk of being potentially exposed to Hepatitis B through blood and other potentially infectious materials, Advantage Home Care is required to offer you the opportunity to receive the vaccination at no cost to you. 

    Would you like to be vaccinated?(Required)
    I understand that due to my occupational exposure to blood and other potentially infectious materials, I am at a higher risk of acquiring hepatitis B virus (HBV) infection. However, at this time I have decided to waive the opportunity for Advantage Home Care to pay for me to get the hepatitis vaccine. I understand that if I change my mind during the course of employment, it is my responsibility to contact Advantage Home Care in order to arrange for reimbursement for the vaccine.
    By checking this box, I am stating that I would like to receive the Hepatitis B vaccination and be reimbursed by Advantage Home Care for the cost to do so. I acknowledge that it is in my best interest to consult with my physician prior to receiving the vaccination. I understand that I am responsible for setting up my own appointment for vaccination, preferably at the local health dept., and am responsible for providing Advantage Home Care with the full receipt and proof of vaccination in order to be reimbursed for my expenses.
    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    New Hire Orientation Plan


    For the positon of In-Home Aide/Caregiver/Homemaker you are required to complete 24 hours of new hire training. You are paid minimum wage for all 24 hours. This training is broken down in the following way:

    • 22 hours of Skills Training: This will consist of an array of topics regarding home care and how to be an In-Home Aide. This can be done remotely or in the office. It consists of videos, interactive training, etc.
    • 2 hours of Agency Orientation: Each new hire will complete 2 hours agency orientation reviewing the handbook and agency policy and procedures.
    I agree to the training program designed for me:(Required)

    Please call the office at (888) 678-2464 between the hours of 8am-5pm, Monday-Friday to speak to a member of our staff.  The training schedule for the job you applied for is mandatory.

    Need Help? Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.

    Acknowledgements / Authorizations


    Background Check Policy(Required)
    I understand that as a part of consideration for employment with Advantage Home Care
    (including Advantage In-Home Services, LLC , Advantage Consumer Directed Services, LLC and
    TPC Advantage, LLC), the Company may obtain background checks that include, but not
    limited to; employment and education verifications, social security verification, criminal and
    civil history, consumer reports that include nationwide background checks, sex offender
    registry, highway patrol records, Department of Motor Vehicle (DMV) records, finger prints,
    public records of any kind, personal interviews and any other information bearing on my
    character, general reputation, personal characteristics and trustworthiness. Missouri
    applicants are required to be registered with the Family Care Safety Registry and Illinois
    applicants are required to be registered with the Health Care Worker Registry as a condition
    of employment. I hereby authorize the Company to register me with the appropriate state
    registrars. If an applicant has lived outside of the state during the past 5 years, the company
    may be required to run a nationwide background screening. I acknowledge that I have
    informed the Company of all names I have used in the past including maiden name and
    aliases. Applicants applying to work in the state of Illinois are not obligated to disclose sealed
    or expunged records of conviction or arrest, nor if they exist. Any offers of employment are
    contingent upon clear results of a thorough background check pursuant to federal and state
    regulations. If an applicant or employee have been found guilty of a prohibited offense,
    regardless of adjudication or a plea of nolo contender, that person would not be eligible for
    hire or continued employment. I understand that if I am hired, this Company participates in
    E-Verify and I will be required to provide photo proof of identity and legal authority to work
    in the United States and that federal immigration laws require me to complete an I-9 Form in
    this regard. I hereby waive all rights and claims I may have regarding the Company, its
    agents, employees or representatives for seeking, gathering and using such information in
    the employment process and all other persons, corporations or organizations for furnishing
    such information. I understand, if I am offered employment, that background checks will
    also be performed at various times throughout employment as required by the healthcare
    industry and state law.
    Job Description(Required)
    Job Summary:
    The Home Service Worker perform various personal care/homemaker chore tasks which are assigned per each client’s individual needs. The Home Service worker assists with activities of daily living, physical comfort, homemaker chore, emotional, and social support to the client. The Home Service Worker supports Advantage In-Home Services’ mission, philosophy, policies and procedures. This position is considered variable hour in that the employee works on a pro re nata basis (PRN).

    Required Qualifications:
    • Must be an active member on the Health Care Worker Registry.
    • 2 references required.
    • Passes all required background checks upon hire and throughout employment; including but not limited to: Criminal/State Highway Patrol, Fingerprint-Based Criminal History Records Check via the Health Care Worker Registry, OIG (Illinois and Federal), Sex Offender, Department of Corrections, E-Verify.
    • Must have active vehicle insurance if driving to and from work, and/ or running errands for client, and/or transporting client (with prior approval).
    • Must have high school diploma or knowledge and skill equivalent, or 1 year of experience as a homemaker through employment or by caring for a dependent child or adult family member.
    • Able to read the client’s written care plan and able to communicate by phone with supervisory and emergency personnel.
    • Able to follow directions and perform to the satisfaction of the client and homemaker supervisor.

    Essential Job Functions:
    • Supports Advantage In-Home Services’ mission, philosophy, agency policies and service approach.
    • Provides direct client care within the scope of knowledge, experience base and training.
    • Maintains client confidentiality in accordance with the agency’s HIPAA and confidentiality policies.
    • Follows all mandated reporter guidelines. Reports any suspicions of abuse and/or neglect to the abuse and neglect hotline.
    • Attends all staff meetings, case conferences and required in-services.
    • Follows all state, federal, and agency guidelines.
    • Independently performs the client specific tasks as assigned on the client’s care plan.
    • Observes, reports, and documents any physical and/or behavioral changes in the client promptly, accurately, and precisely to the Homemaker Supervisor.
    • Provides assistance with activities of daily living, housekeeping, personal laundry, and companionship.
    • Assists the client in meeting the demands of living independently.
    • Completes appropriate reporting documents such as timesheets, progress notes, incident reports, etc.
    • Accurately utilizes the agency’s Electronic Visit Verification system for all shifts worked, per state and federal guidelines.
    • Confirms on a weekly basis, the scheduling of shifts with the agency.
    • Properly notifies agency if unable to make it to scheduled shift, including absences due to illness, emergency leave, and scheduled vacations.
    • Weekly Electronic Visit Verification records/timesheets/EVV correction forms must be completed accurately; including in/out times, tasks performed, and client signatures for every shift worked. Paperwork must be not pre-filled out, or be completed after the shift has already been worked. Documentation must take place during shift.
    • Any paperwork must be submitted to branch office on a weekly basis.
    • Maintains a clean and safe environment as directed by family and client’s plan of care.
    • Able to communicate both orally and in written form to client, family, and/or caregiver.
    • Able to quickly respond to emergency situations involving the safety of the client.
    • Contacts 911 immediately for life threatening situations. Notifies Homemaker Supervisor when the client is stable.

    Functional Requirements
    • Home Service Workers must physically be able to assist the client with the following: dressing, feeding, hair care, mouth care, shaving (electric or safety razor only) nail care (excluding nail trimming), positioning, toileting, and transfers.
    • Must be able to assist client with assistive devices (skills training required): wheel chair, walker, hoyer lift, gait belt.
    • Able to push and pull a client at a minimum of 100 pounds.
    • Able to lift a client at a minimum of 50 pounds.
    • Ability to move in tight spaces, between objects and furniture.
    • Able to perform duties which require standing, walking, squatting, climbing stairs, bending, kneeling, twisting, sitting, reaching at, below, and over shoulder limits.
    • Able to continuously perform physical functions for up to an hour without rest.

    This job description is meant to be an overview of general duties assigned to this position. I understand that there may be times that the job requirements may need to be altered to meet the needs of client. If I ever have any questions or concerns regarding work requested of me from the client I will contact my supervisor.
    Non-Disclosure and Non-Solicitation Agreement(Required)
    CONFIDENTIALITY, NON-DISCLOSURE AND NON-SOLICITATION AGREEMENT

    This Confidentiality, Non-Disclosure and Non-Solicitation Agreement (“Agreement”) is made and entered into in the State of Missouri by and between TPC Advantage, LLC, a Missouri limited liability company and all related companies (collectively, “Advantage” or “Employer”) and the “Employee” named in this application as of the date the “Employee” provided their acknowledgment of the agreement contract terms.

    WHEREAS, Employee acknowledges Employer is engaged in a specialized and highly competitive business providing, among other services,

    WHEREAS, Employer desires to employ (or continue to employ) Employee and Employee desires to be employed (or continue to be employed) by Employer as an In Home aide and/or Consumer Directed Services Attendant and

    WHEREAS, Employee acknowledges that the execution of this Agreement is an express condition of Employee’s employment (or continued employment) with Employer; and

    WHEREAS, no contract regarding the length of employment is created by this Agreement and the employment relationship between Employer and Employee is terminable at the will of either party.

    NOW, THEREFORE, in consideration of Employee’s employment (or continued employment) with Employer, and for other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, Employer and Employee hereby agree to execute and be bound by this Agreement as follows:

    1. DEFINITIONS: In this Agreement:
    Client or Clients means any individual, couple, group of individuals, or other entity that has been solicited, contacted, or served by Employer at any time during the twenty-four (24) month period prior to the discontinuation of Employee’s employment with Employer.
    Referral Source means any individual, proprietorship, partnership, corporation, association or other entity that has referred Clients to Employer at any time during the twenty-four (24) month period prior to the discontinuation of Employee’s employment with Employer.
    Competing Business means any individual, proprietorship, partnership, corporation, association or other entity other than Employer which: (i) is engaged in, or is about to be engaged in, non-medical home care service, skilled nursing visits, personal care services, attendant services, companion services, pediatric care, consumer directed care, house cleaning, grooming, meal preparation, respite care, and medication assistance and reminders.

    Trade Secrets mean any technical information and business information that generally facilitates the sale and performance of Employer’s services, increases revenues, or provides an advantage over Employer’ competitors and is not generally known.
    Know-How means all factual knowledge and information related to Employer’ business which is not capable of precise, separate description but which, in accumulated form, after being acquired as a result of trial and error, gives to the one acquiring it the ability to produce and market something which one would otherwise not have known how to produce and market with the same accuracy or precision necessary for commercial success, provided, however, that such knowledge and information is not in the public domain or readily available to any third party other than a limited number of persons who have agreed to keep that information secret.
    Confidential Information is information acquired by Employee in the course and scope of his or her activities for Employer or to which Employee is, was or will be exposed to by Employer that is designated by Employer as “confidential” or that Employer indicates through its policies, procedures, or other instructions, or by this Agreement, should not be disclosed to anyone outside Employer except through controlled means. Confidential Information need not be a Trade Secret, Intellectual Property, or Know-How to be protected under this Agreement. The parties to this Agreement specifically agree that, regardless of its affect on trade secret status, the controlled and limited disclosure of Confidential Information to third parties for legitimate business purposes and the availability of the Confidential Information to others outside Employer through independent investigation and effort will not remove it from protected status as Confidential Information under this Agreement if Employee was first entrusted with the Confidential Information while employed by Employer. “Confidential Information” includes, but is not limited to, any and all trade secrets and/or confidential, financial or business information of Employer, or any of its direct or indirect subsidiaries or affiliates, including, but not limited to, (i) names, addresses, phone numbers, e-mail addresses, w-2 information, work history, qualifications, work performance and contact information for Employer’s employees, (ii) names, addresses, telephone numbers and e-mail addresses of customers/clients (and key contacts related to customers/clients), and other business information concerning the level of business provided to any such customer/client, the business preferences and requirements of any such customer/client, prices charged such customer/client, or other business information which otherwise would be of assistance in marketing, serving and/or retaining any such customer/client, (iii) financial statements or reports, marketing or business plans, marketing or business techniques, market analysis, marketing or business plan development material, management information system material, Employer’s statistical information, prices charged customers, quality assurance data, financial status, profits, profit margins, accounts receivable and payment information, and other financial information of or concerning Employer, or any of its respective direct or indirect subsidiaries or affiliates, (iv) marketing and bidding information, rates, price and quotation techniques and methods, sales volumes and profits, margins, marketing plans, strategies and projections, business methods, forms and procedures, (v) operating procedures and manuals, forms, policy manuals, customer/client evaluation procedures, standard of care and outcome measurement data, and companies and contacts from whom Employer, or any of its respective direct or indirect subsidiaries or affiliates obtains various products for sale, resale and marketing, (vi) lists of customers/clients, including but not limited to, any such information maintained on any computer system or data base, (vii) computer software or other data, (viii) accounting information, cost information, discount information, pricing and pricing structure, source codes and/or object codes, technical data, product specifications (of Employer, or any of its respective direct or indirect subsidiaries or affiliates and of any customer of any such business or entity), sales and other records, process technology, lists of customers, and computer software systems and programs, (ix) trade secrets, software, object code, manuals, product design, plans, financial information, software designs and programs, sales and customer information, and other information of Employer, (x) personnel and internal business records and plans, and other information that may not be known generally or publicly outside Employer, or any of their respective direct or indirect subsidiaries or affiliates which gives such business or entity an advantage over its competitors who do not have access to or know or use it, and (xii) other information concerning Employer and customer projects, proposals, financial and operating data.
    Company Information means Trade Secrets, Know-How, and Confidential Information (recognizing that certain information and material will fall into multiple categories).

    2. CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT: Employee recognizes and acknowledges that Employer has a legitimate business interest to keep certain information confidential at all times. Employee further acknowledges that Employer’s Confidential Information, including, but not limited to, referral sources, clients, and customers of Employer who utilize or are serviced by Employer’s programs as well as the employees and staff who are employed by Employer, are valuable and unique assets of the Employer’s business and were acquired and developed at considerable expense to the Employer. Effective immediately and at all times thereafter, Employee shall hold in strictest confidence and shall not disclose to any person, firm, corporation, partnership, agency, commission, institution or other entity, without the express prior written authorization of the President of Employer, or any other designee selected by the President of Employer, any Confidential Information, Trade Secrets, Know How and/or Company Information relating to any business of Employer.
    (a) By virtue of Employee’s employment by Employer, Employee will become familiar with and possess documents and information which are Confidential Information, Trade Secrets, Intellectual Property and/or Company Information, as defined in this Agreement, and Employee will become personally acquainted with certain Referral Sources and Clients of Employer. Employee further acknowledges that Employee will acquire a special relationship with many of the Employer’s Clients and Customers through this employment. Employer and Employee specifically agree and acknowledge that any and all Confidential Information or Trade Secrets provided by Employer or otherwise obtained by Employee during the term of this Agreement is proprietary, unique and commercially sensitive in nature, represents in many instances advanced and state of the art technology, and has been developed over time and reflects a substantive investment by Employer. Employee further acknowledges that Confidential Information and Trade Secrets provided by Employer are not matters of public or general knowledge in the industry and that Employer derives economic value (whether actual or potential) from such information. Employee acknowledges Employer has maintained substantial secrecy concerning the Confidential Information and Trade Secrets and that absent disclosure by Employer to Employee, Employee could not otherwise have readily ascertained by proper means, and/or have acquired knowledge of such confidential or proprietary information and trade secrets.
    (b) In the event of termination of employment for any reason, Employee shall immediately deliver to Employer all of Employer’s property, including, but not limited to, all copies and electronically stored versions of any Employer’s property, containing or relating to any Confidential Information, Trade Secrets, and/or Company Information, as defined in this Agreement, and all other business records as well as all other Employer’ property in Employee’s possession and over which Employee has control.
    (c) Employee will not, without the prior written consent of Employer, during or at any time after the period of his/her employment by Employer, use for his/her own use or any other’s use or benefit, any Confidential Information, Trade Secrets, and/or Company Information obtained during, after or as a result of employment by Employer.
    (d) Employee acknowledges and agrees that Employee will have access to Confidential Information (including the information contained in this Agreement) and that Employee shall not in any manner, directly or indirectly, disclose or divulge Confidential Information to any other person, firm, corporation or other third party for any use or purpose, except as required by law or with the express written authorization of Employer.
    (e) The Confidentiality and Non-disclosure obligations and covenants expressed herein shall remain in full force and effect during Employee’s employment with Employer and during or at any time after the period of Employee’s employment with Employer.
    (f) Employee understands and acknowledges that any violation of this Section 2 is grounds for immediate termination.

    3. NON-SOLICITATION AGREEMENT:
    (a) Employee acknowledges that, along with access to Employer’s Confidential Information, Employee will acquire a special relationship with many of the Employer’s Clients, Customers, and employees through employment with the Employer.
    (b) During Employee’s employment by Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee shall not, without the prior written consent of Employer, in any manner, directly or indirectly, either individually or as an employee, owner, partner, consultant, shareholder, director, officer or agent of another, for his/her own benefit or on behalf of any person, firm, partnership, entity or corporation, solicit, recruit, hire, retain, employ, create a business relationship with, or endeavor to solicit, recruit, hire, retain, employ or create a business relationship with any current employee of Employer or any former employee of Employer who was employed by Employer at any time during the one year period (365 days) immediately prior to the discontinuation of Employee’s employment with Employer.
    (c) Employee further agrees that during his/her employment with Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee will not directly or indirectly, on Employee’s own behalf or on behalf of any third party, or as a sole proprietor, joint venture, partner, employee, officer, director, consultant, shareholder, investor, or otherwise solicit the business of any of Employer’s Clients, customers or referral sources, or contact such Clients, customers, or referral sources for any business purpose that is competitive with Employer’s business.
    (d) Employee further agrees that during his/her employment with Employer and for a period of two years (730 days) after discontinuation of Employee’s employment with Employer, for whatever reason and whether the discontinuation of such employment was voluntary or involuntary, Employee will not directly or indirectly, on Employee’s own behalf or on behalf of any third party, or as a sole proprietor, joint venture, partner, employee, officer, director, consultant, shareholder, investor, or otherwise encourage any of Employer’s Clients, customers or referral sources (i) to modify their business relationship with Employer or (ii) not to establish or not renew their business relationship with Employer.
    (e) Employee understands and acknowledges that any violation of this Section 2 is grounds for immediate termination.

    4. ACKNOWLEDGEMENTS. Employee acknowledges and agrees that Employee has the experience, knowledge and capabilities to obtain employment notwithstanding the restrictions in Section 2 and Section 3 and thus Employee has a means to support himself or herself and Employee’s dependents other than by engaging in the activities restricted by the terms of Section 2 and Section 3 and that the terms of Section 2 and Section 3 will not impair such ability. Employee further acknowledges and agrees that enforcement of this Agreement through an injunction will not prevent Employee from earning a living and supporting himself or herself. Employee also acknowledges and agrees that this Agreement does not constitute a contract of employment, Employee’s engagement with Employer is at-will and may be terminated at any time for any or no reason, and nothing herein shall be interpreted as providing Employee the right to continued employment by Employer or provide Employee any right to any compensation or payment upon Employee’s termination.

    5. GOODWILL. Employee acknowledges that Employer has developed, over a period of time, and will continue to develop, significant relationships and goodwill between itself and its Clients and Referral Sources by providing superior services. Employee further acknowledges that these relationships and this goodwill are a valuable asset belonging solely to Employer. Employee further acknowledges that any business relationship that he or she brings or has brought to Employer will belong to and will inure to the benefit of Employer after Employee begins his or her employment. Finally, Employee acknowledges that the responsibility to build and maintain business relationships and goodwill with current and prospective Clients and Referral Sources creates a special relation¬ship of trust and confidence between him or her, Employer, and its Clients and Referral Sources. Employer promises to permit Employee to use its goodwill with its current and prospective Clients and Referral Sources to enable Employee to perform his or her duties for Employer.

    6. RETURN OF EMPLOYER PROPERTY Employee acknowledges that all written records, databases, CDs, DVDs, disks and other electronic storage media containing information relating to Employer business, including, without limitation, memoranda, notes, correspondence, reports, manuals, books, papers, letters, Client profile data, Client lists, contracts, software programs, drafts, and other documentation (whether in draft or final form, and whether in paper or electronic format), marketing plans, and other sales, financial or technical information relating to Employer’s business, and any and all other documents containing Company Information furnished to Employee by any representative of Employer or otherwise acquired or developed by him or her in connection with his or her association with Employer (collectively, "Recipient Materials") shall at all times be Employer’s exclusive property. Within twenty-four (24) hours of the termination of his or her employment, Employee promises to return any Recipient Materials that are in his or her possession, custody or control, regardless of whether such materials are located in Employee’s office, home, automobile, personal computer, electronic storage media or elsewhere. Employee also shall authorize and permit Employer to inspect all computer drives and electronic storage media used or maintained by Employee during his or her employment and, if necessary, to permit Employer to delete any Recipient Materials or Company Information contained on such drives or storage devices. Additionally, within twenty-four (24) hours of the termination of his or her employment, Employee agrees to return to Employer any equipment or other tangible property which Employee received from Employer during his or her employment, including, but not limited to, desktop and laptop computers, printers, monitors, cellular telephones, pagers or other personal com¬munication devices, credit cards, access cards, security cards, keys and employee manuals which are in Employee’s possession, custody or control, and shall disclose to Employer any and all passwords or codes required to gain access to such devices.

    7. REMEDIES FOR VIOLATION: Employee acknowledges that the damages which will be suffered by Employer by a breach of any term or provision of this Agreement may be continuing and irreparable, but will also be difficult or impossible to ascertain in money or money’s worth. Consequently, in addition to any action at law for damages, Employee agrees that Employer may have equitable relief, including specific performance and injunctive relief, including temporary restraining orders and preliminary, permanent and mandatory injunctions, to ensure and enforce his/her performance of such obligations. If such action becomes necessary, Employee further agrees to pay the attorneys’ fees and costs incurred by Employer in the enforcement of these contract provisions, whether or not litigation is initiated.

    8. NON-WAIVER: Employer’ failure to exercise any of its rights in the event Employee breaches any of the separate and distinct promises in this Agreement shall not be construed as a waiver of such breach or prevent Employer from later enforcing strict compliance with any and all promises in this Agreement.

    9. BINDING EFFECT: This Agreement shall be binding upon and shall inure to the benefit of Employer, its successors and assigns.

    10. ASSIGNMENT: This Agreement can only be assigned by Employer.

    11. MODIFICATION: This Agreement contains the parties’ complete understanding regarding the subject matters contained herein, and there are no other agreements, oral or written, pertaining to the subject matters of this Agreement. Any amendments to this Agreement must be in writing and signed by the parties.

    12. DISCLOSURE OF EXISTENCE OF AGREEMENT: In order to preserve Employer’s rights under this Agreement, Employer may advise any third party of the existence of this Agreement and of its terms and may provide such third party copies hereof, and Employer shall have no liability for doing so. Employee shall notify each subsequent employer or person or entity using the services of Employee at any time within two (2) years following the termination of Employee’s employment with Employer of the existence and provisions of this Agreement. Employee shall also notify Employer in writing of the name, principal business address, primary area of business, and any area of business competitive with the business of Employer of each person or entity by whom Employee is employed or otherwise engaged to provide services at any time within two (2) years following the termination of Employee’s employment with Employer.

    13. PRIOR AND/OR PRESENT EMPLOYMENT: Employee represents and warrants to Employer that Employee is not a party to any agreement containing a noncompetition provision or other restriction with respect to (a) the services or business that Employee is required to perform or conduct for Employer or (b) the disclosure or use of any information which directly or indirectly relates to the nature of the business of Employer or the services to be rendered by Employee to Employer. Employee further certifies that he/she has not disclosed or used, and will not disclose or use, during Employee’s employment by Employer, any confidential information that Employee acquired as a result of any previous employment or under a contractual obligation of confidentiality before Employee’s Employment by Employer.

    14. INTERPRETATION, JURISDICTION & VENUE: This Agreement shall be interpreted, governed and construed according to the laws of the State of Missouri without reference to conflict of law principles and notwithstanding the place of execution hereof or the performance of any acts under this Agreement in any other jurisdiction. Employee agrees that the State of Missouri bears a substantial relationship to the parties and the transaction between the parties under this Agreement and each party consents to the personal jurisdiction of the state and federal courts located in the State of Missouri for purpose of any suit, action or other proceeding arising out of this Agreement. Employee waives any argument that venue in any such forum is not convenient. Employee and Employer each agrees that the venue of any litigation initiated by either of them in connection with this Agreement shall be in either the Circuit Court of St. Louis County, Missouri, or the United States District Court for the Eastern District of Missouri.

    15. HEADINGS: Paragraph headings are for reference purposes only and do not restrict or limit in any way any subject matters contained in this Agreement.
    16. ACKNOWLEDGEMENT: BY SIGNING THIS AGREEMENT, EMPLOYEE ACKNOWLEDGES THAT HE/SHE HAS READ THE AGREEMENT, THAT HE/SHE UNDERSTANDS THE AGREEMENT AND INTENDS TO FULFILL EACH AND EVERY ONE OF THE PROMISES IN THIS AGREEMENT, THAT EMPLOYEE UNDERSTANDS THAT THIS IS A LEGALLY BINDING AGREEMENT, THAT EMPLOYEE HAS RECEIVED A COPY OF THIS AGREEMENT AND THAT EMPLOYEE UNDERSTANDS, ACKNOWLEDGES AND AGREES THAT THE PROMISES MADE HEREIN ARE REASONABLE AND NECESSARY TO PROTECT EMPLOYER’ LEGITIMATE BUSINESS INTERESTS.

    IN WITNESS WHEREOF, this Agreement has been executed as of the date the employee acknowledged their agreement.

    EMPLOYEE: I understand that by acknowledging this agreement in the online onboarding paperwork, I am agreeing to the terms listed in the agreement.
    Pet Care - Are you able to work with clients with pets?(Required)
    Pet Care Policy(Required)
    Pet Care Policy:
    Homemakers are required to perform general pet care tasks while working for CCP clients that own a pet.
    This includes:
    buying pet food while doing other client shopping;
    putting food and water in pet’s bowl;
    letting an animal in or out of the home;
    cleaning pet’s litter box, except in cases which would endanger the health of the worker
    Tasks that are not required to be performed include:
    walking the pet;
    grooming or trimming the pet;
    clipping the pet’s nails;
    excessive cleaning up after the pet inside the home;
    cleaning up after the pet outside the home
    Respiratory Services Training(Required)
    There may be times where care for a client that requires respiratory services. It is important to
    understand what your role is while you are caring for this type of client. There are certain tasks that you
    are prohibited from doing, that would require a skilled agency to perform. If you find yourself in a
    situation where skilled care is needed, please contact your supervisor immediately!
    If you observe that your client is in respiratory distress, you must contact 911 immediately for
    assistance. After 911 has been contacted, when the time is right, you should contact your supervisor to
    make them aware of the incident. Following notification of the respiratory incident, the agency will
    notify the proper parties.

    Below are the tasks that are allowable to perform for a client that requires respiratory services:

    1. Temporarily removing and replacing cannula or mask from the client’s face for the purpose of
    shaving or washing a client’s face
    2. Temporarily removing cannula or mask in order for the client to eat

    Examples of respiratory care that is considered skilled and requires a skilled nursing agency to perform includes:
    postural drainage;
    cupping;
    adjusting oxygen flow within established parameters;
    nasal, endotracheal and tracheal suctioning;
    and turning off or changing tanks

    These types of tasks are prohibited and you must contact the office immediately if your client is
    requesting you perform any type of respiratory service that is medical in nature.
    EVV Policy(Required)
    The Law:

    This notice is to make you aware that the state of Illinois and the federal government has mandated the use of EVV (Electronic Visit Verification). This rule is in affect for all Medicaid-funded personal care services.

    What is EVV?

    EVV stands for Electronic Visit Verification. The use of EVV means that the caregiver will electronically clock in and out for their shift by means of landline telephone or a smart phone based app. This technology records their exact time of clocking in, clocking out, and the tasks they perform as well as GPS to monitor where services were rendered. If they are using the client’s landline, it is very important that the caregiver has access to use the client’s telephone when they arrive at the home to start services, and again when they have completed their services and are done for the day.
    The caregiver will be trained on how to properly use the EVV system and Advantage In-Home Services’ EVV policy. If the caregiver chooses not to utilize the EVV system properly, disciplinary action including termination is possible.

     

    Applicant Name:(Required)
    Release(Required)

    I hereby authorize my current and/or past employers to release any and all references and records related to my current or past employment and work history to Advantage Home Care. I release you and your company from any and all liability for providing information regarding my employment and work history. I also authorize for Advantage Home Care to contact any references that I have provided to them and understand that if requested, identifying information other than my name may be provided in order to properly identify me (address, social security number, etc.).

    Vehicle Operations(Required)

    I acknowledge that I am not allowed to operate a vehicle while working for Advantage Home Care in any capacity without a valid driver’s license and car insurance. 

    Hepatitis B(Required)

    I acknowledge that my choice to receive or not to receive the Hepatitis B vaccination offered to me is solely my decision and I do not hold Advantage Home Care or its affiliates responsible for any health-related issues related to my decision. 

    E-Signature: By checking this box and clicking the “Submit” button below, I confirm the information submitted is accurate and that I am agreeing and consenting with the information above*(Required)

    Applicant Statement and Acknowledgement

    Please read the following statements carefully before electronically signing this application. Only applications that are e-signed, dated and completed in full are considered valid.

    • I certify that all information I have provided is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application, or immediately discharge me from the employer’s service, whenever it is discovered.
    • I authorize, Advantage In-Home Services, LLC and/or Advantage Consumer Directed Services, LLC, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application.
    • I authorize Advantage In-Home Services, LLC and/or Advantage Consumer Directed Services, LLC to run various state and federal background checks on me prior to hire and during the course of my employment if I should become an employee.
    • I understand that my potential employment and/or continued employment is contingent on the results of these initial and ongoing background check findings. I understand that Advantage In-Home Services, LLC and/or Advantage Consumer Directed Services, LLC has the right to terminate this application and any future employment relationship if there are findings on any state or federal background check regardless of funder source rules on what crimes are considered disqualifying.
    • I hereby waive any and all rights and claims I may have regarding Advantage In-Home Services, LLC and/or Advantage Consumer Directed Services, LLC, its agents, employees or representatives for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information.
    • I understand that Advantage In-Home Services, LLC and/or Advantage Consumer Directed Services, LLC does not unlawfully discriminate in employment and no question on the application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
    • I understand that Advantage In-Home Services, LLC and Advantage Consumer Directed Services, LLC are Equal Opportunity Employers/Vendors and Drug Free Workplaces.
    • I understand that this application remains current for only 90 days. At the conclusion of that, if I have not heard from the employer/CDS vendor and still wish to be considered for employment, it may be necessary to reapply and fill out a new application.
    • I understand that this application does not constitute an agreement or contract for employment.
    • I understand that I may be required to pass a drug test during employment post-accident/incident or for cause.
    • I understand that Advantage In-Home Services, LLC and/or Advantage Consumer Directed Services, LLC participates in E-Verify and I will be required to provide photo proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
    • I acknowledge that if I am applying to be an attendant through the CDS program, I understand that Advantage Consumer Directed Services, LLC is NOT my employer but acts as a third-party vendor and is acting on behalf of the CDS Consumer. The CDS Consumer makes the decision on who to offer employment to.
    • I authorize Advantage In-Home Services, LLC and/or Advantage Consumer Directed Services, LLC to deposit my paycheck into the account I selected in this application.
    I have read and understand the foregoing statements and accept the same as conditions of my employment.(Required)
    Call our recruitment hotline at (888) 678-2464 between the hours of 8am – 5pm, Monday – Friday.
    This field is for validation purposes and should be left unchanged.
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