Careers – Northland home health

Careers at Northland Home Health

We are proud to be a culturally diverse company and are always looking for awesome people to add to our team. All positions are part-time unless otherwise stated. Employees have the option to add additional clients to increase their weekly hours up to 40 per week. We allow the employee and client(s) to create their weekly schedules together.

All applicants must pass an MN Department of Human Services background check AND complete training before being authorized to work.

If you would like to apply for a position, please fill out the application form below and email it to info@northlandhomehealth.com or bring it to your local Homeland office.

Employment Applicaion

Personal Information

POSITION APPLIED FOR

PCA HOME MAKER INDEPENDENT LIVING SKILLS TRAINER OFFICE

DATE AVAILABLE

WHERE DID YOU HEAR ABOUT THE OPEN POSITION?

WHAT OFFICE ARE YOU APPLYING FOR? St. Paul Minneapolis St. Cloud

MILITARY SERVICE?

Yes No

From - To

ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES OF AMERICA?

Yes No

HAVE YOU BEEN CONVICTED OF A FELONY?

Yes No

IF YES, PLEASE EXPLAIN:

US CITIZEN?

Yes No

PLACE OF BIRTH

HAVE YOU HAD ANY PREVIOUS DOCUMENTED NAME OR ALIAS?

Yes No

FIRST

MIDDLE

LAST

IN THE LAST 5 YEARS, HAVE YOU LIVED IN A STATE OTHER THAN MINNESOTA?

Yes No

STATE

From - To

OK TO WORK WITH PERSONS WHO ARE/HAVE (CHECK ALL THAT APPLY)

ELDERLY ADULTS CHILDREN MALE FEMALE SMOKE CATS DOGS EXOTIC PETS

FORMS OF TRANSPORTATION (CHECK ALL THAT APPLY)

BUS TRAIN CAR NONE

DO YOU HAVE ANY ALLERGIES THAT WOULD EFFECT YOUR WORKING IN SOMEONE'S HOME?

Yes No

DO YOU HAVE ANY EXPERIENCE AS A PERSONAL CARE ASSISTANT?

Yes No

ARE YOU COMFORTABLE WORKING WITH CLIENTS THAT MAY REQUIRE BATHROOM ASSISTANCE?

Yes No

ARE YOU COMFORTABLE WORKING WITH CLIENTS THAT REQUIRE A RANGE OF MOTION PROGRAM?

Yes No

ARE YOU COMFORTABLE WORKING WITH CLIENTS THAT REQUIRE A BOWEL PROGRAM?

Yes No

Prior Work Experience

CURRENT OR MOST RECENT

PRIOR

DATES OF EMPLOYMENT

May We Contact?

Yes No

May We Contact?

Yes No

May We Contact?

Yes No

Education

HIGH SCHOOL

COLLEGE/UNIVERSITY

HIGH SCHOOL

OTHER

Did You Graduate?

Yes No

Did You Graduate?

Yes No

Did You Graduate?

Yes No

Did You Graduate?

Yes No

UPLOAD ANY CERTIFICATES AND IDS

Availability

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

References

PROFESSIONAL

PERSONAL/PROFESSIONAL

Emergency Contacts

PRIMARY

ALTERNATE

Employee Intake: Informed Consent

I hereby give NORTHLAND HOME HEALTH, LLC the right to make a thorough investigation of my past employment, education, and activities. I release NORTHLAND HOME HEALTH, LLC, and/or its agents from all liability to retrieve information from any/all government agencies, social service agencies, and law enforcement agencies, to supply any and all information concerning my background, and release the same from any liability resulting in providing such information. NORTHLAND HOME HEALTH, LLC does not run credit reports, but is required to conduct criminal conviction searches during the hiring process. I understand that I am required to pass a criminal background check by the Minnesota Department of Human Services and understand that if for any reason I would be disqualified, NORTHLAND HOME HEALTH, LLC. cannot proceed with my employment.

I understand that if my application for employment is granted NORTHLAND HOME HEALTH, LLC. may obtain further information through subsequent investigations by a consumer reporting agency so as to evaluate me in regard to promotion, reassignment, retention, and to comply with operating license and/or liability insurance requirements and/or applicable state/federal laws. This includes initial and annual criminal conviction searches as well as investigations resulting from possible employment misconduct, negligence, and/or incidences/accidents involving my employment with NORTHLAND HOME HEALTH, LLC. its clients, consumers, agents and/or assigns. This document is valid throughout the course of my employment. I understand that the disclosure of a criminal record will not automatically disqualify me from employment consideration and that my case will be judged on its merits and according to MN DHS rules and regulations. I understand that any false answers, statements, or implications made by me in any application or other required documents, or acts of willful misconduct pertaining to my employment shall be considered sufficient cause for denial or employment discharge.

I hereby release any individual or institution, including its officers, employees, or related personnel, birth individually and collectively, from any/all liability for damages of whatever kind, which, at the time result to me, because of compliance with this authorization and request to release information or any attempt to comply with it.

I understand that a consumer and/or investigative consumer report for the purpose of employment will be obtained.

MN RESIDENCE ONLY: I WOULD LIKE A COPY OF ANY CONSUMER REPORT REGARDING ME.

Yes No

I AM WILLING THAT A PHOTO COPY OR ELECTRONIC COPY OF THIS CONSENT FORM BE ACCEPTED WITH THE SAME AUTHORITY AS THE ORIGINAL.

Yes No

I HAVE READ AND UNDERSTAND THE ABOVE CONTENT.

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