Welcome to our Texas United Home Health Family!

Current Openings

Managing Director (RN), PRN (RN & LVN), CNA

Title: Employment Application

Applicant Name*

Email Address*

Current Address*

City, State, Zip*

Cell Phone*

Name and Address of next of kin*

Are you at least 18 years old?*

Yes

No

Position Applying For*

Availability*

Full Time

Part Time

Part Time Per Visit

Pool

Shift*

Day

Evening

Night

Weekends

If you are not a US citizen, do you have the legal right to remain permanently in the US?*

Yes

No

Salary Requirements and Date Available*

Do you have adequate means of transportation to get to work on time each day, and when called in on short notice during normal work hours?*

Yes

No

High School*

Last Year Attended*

9

10

11

12

Graduated

Yes

No

College

Last Year Attended

1

2

3

4

Graduated

Yes

No

Degree

College

Last Year Attended

1

2

3

4

Graduated

Yes

No

Degree

Other

Last Year Attended

Graduated

Yes

No

Degree

List professional licenses you possess. Indicate type (i.e., license, certification, registration, etc.), number and issuing state*

List any memberships in professional organizations, honors, or activities which you feel would enhance your application, excluding those that would indicate race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law

List languages spoken other than English

List other skills applicable to the position for which you are applying, including computer experience, typing speed, etc.

Work History*

Complete Address including city, state, zip*

Phone Number*

Supervisor's Name*

Dates of Employment*

Type of Business*

Full Time

Part Time

Per Visit

Reason for Leaving*

Ok to Contact Supervisor*

Yes

No

Describe your job title, responsibilities, and accomplishments*

Work History

Complete Address including city, state, zip

Phone Number

Supervisor's Name

Dates of Employment

Type of Business

Full Time

Part Time

Per Visit

Reason for Leaving

Ok to Contact Supervisor

Yes

No

Describe your job title, responsibilities, and accomplishments

Work History

Complete Address including city, state, zip

Phone Number

Supervisor's Name

Dates of Employement

Type of Business

Full Time

Part Time

Per Visit

Reason for Leaving

Ok to Contact Supervisor

Yes

No

Describe your job title, responsibilities, and accomplishments

Additional Work Experience

I certify that the information in this application is true and complete for all practical purposes. It may be verified by the Agency or any affiliate. Should a position be offered and later it is found that the information is significantly untrue, incomplete, or misrepresented, I understand and agree that the Agency or its affiliates are relieved of all commitments, financial or otherwise pertinent to employment, and that I am subject to immediate termination without recourse. I understand and agree that if I am offered employment by the Agency, my employment will be for no definite term and that either I, or the Agency will have the right to terminate the employment relationship at any time, with or without cause, and with or without notice. I also understand that this status can only be altered by a written contract of employment which is specific as to all material terms and is signed by me and the Administrator of the Agency. I understand, if I have direct patient contact that the Agency will perform a background check, including criminal history check, OIG exclusion list check (if applicable), and any additional checks as required by accrediting body standards or State Regulations. I further understand, if I am an unlicensed person, the Agency will perform a check of the Nurse Aide Registry and Employee Misconduct Registry. I understand that: 1) the purpose of the Employee Misconduct Registry is to ensure that unlicensed personnel who commit acts of abuse, neglect, exploitation, misappropriation, or misconduct against residents and consumers are denied employment in HHS-regulated facilities and agencies; 2) the State of Texas maintains a registry of all nurse aides who are certified to provide services in nursing facilities and skilled nursing facilities licensed by the Texas Health and Human Services (HHS) and they review and investigate allegations of abuse, neglect, or misappropriation of resident property by nurse aides and if there's a finding of an alleged act of abuse, neglect, or misappropriation, the nurse aide may request both an informal reconsideration and a formal hearing before the finding is placed on the registry; 3) All HHS-regulated facilities and agencies are required to check the Employee Misconduct Registry and Nurse Aide Registry before hire to determine if I am listed in either registry as having committed an act of abuse, neglect, exploitation, misappropriation, or misconduct against a resident or consumer and am, therefore, unemployable. I understand that a refusal to authorize the criminal background check may result in adverse employment action, such as rejection of the application or termination of employment. Release: I hereby authorize any prior employers to provide such information concerning my employment with them as may be requested, and also authorize the Registrar / Placement Office of all educational institutions attended to release an official copy of my transcript and, if available, faculty appraisals. I also authorize any appropriate licensing board to release full information concerning my license status and my license history.

Applicant Signature*

Job Description

Confidentiality / Conflict of Interest Disclosure Statement

Statement of Employability

HIPAA-PHI Protection Agreement

Compliance Pledge

Reference Request Acknowledgement

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Employee Handbook

Employee Acknowledgement

Orientation

Hepatitis B Vaccination

TB Risk Assessment and Symptom Evaluation

Submit/Upload Documents

Complete this section if applying for an RN position Job Description / Performance Evaluation

Title: Registered Nurse

Job Summary: Primary functions are to administer skilled nursing care for patients of all ages in their place of residence and to coordinate care with the interdisciplinary team, patients, families, and referring agency. Assumes the responsibility for, and participates in, the coordination of care.

Reports to: Administrator

Job Qualifications:

Education: Graduate from an accredited diploma, associate, or baccalaureate nursing program.

Licensure: Active, state license as a registered nurse, or a multi-state license issued by a Nurse Licensure Compact (NLC) member state. Current driver’s license.

Experience: One year of experience as a registered nurse in a clinical care setting. Home health experience preferred.

Skills: Nursing skills as defined as generally accepted standards of practice. Good interpersonal skills. Proof of current CPR certification.

Transportation: Reliable transportation and valid auto liability insurance.

Environmental and Working Conditions: Works in patients’ homes in various conditions; possible exposure to blood, bodily fluids, and infectious diseases; ability to work a flexible schedule; ability to travel locally; some exposure to unpleasant weather; PRN emergency calls.

Physical and Mental Effort: Prolonged standing and walking required, with ability to lift up to 50 pounds and move patients. Requires working under some stressful conditions to meet deadlines and patient needs, and to make quick decisions and resource acquisition; meet patient and family individualized psychosocial needs. Requires hand-eye coordination and manual dexterity.

Statement of Understanding: I have read the above job description and essential functions. I understand and agree to carry out these responsibilities as assigned. I will adhere to Agency compliance with laws and regulations in a professional manner. I understand and acknowledge that nothing contained in this job description may be construed as limiting the employer’s right to discipline or terminate my employment at any time for failure to perform satisfactorily.

I have downloaded and reviewed the electronic copy of the Job Description and Performance Evaluation.

Applicant Signature*

Job Description and Performance Evaluation

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Reference Request

View Copy of Reference Request

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Statement of Employability

Title: Statement of Employability

Last Name, First, Middle*

By execution of this document, I acknowledge that I have been informed by the Agency and agree that the Agency may conduct a State of Texas criminal history check per Texas H&SC 250.006. I agree to a search of the Nurse Aide Registry and the Employee Misconduct Registry prior to employment and at least every 12 months if hired. As required, I agree to a search of the Texas Health and Human Services Commission’s OIG List of Excluded Individual/Entities, prior to being hired and monthly thereafter, the HHS - OIG Excluded Individuals/Entities Search Database and SAM Exclusion List. I understand that these checks will determine if I have a criminal conviction or have committed certain conduct that will bar me from employment with this Agency. I understand that I am unemployable if listed as unemployable in the NAR or EMR per TAC 26 TAC Chapter 561, §561.3 and Texas H&SC Chapter 253.

Criminal History Check

I have informed the Agency of all names (i.e., maiden, aliases) that I have used in the past. I understand that my employment is pending the results of the criminal history check, and that I may not have face-to-face patient/client contact until results are returned. I will be notified of results.

I acknowledge that if I am found to have been convicted of any offense(s) barring employment, that these offenses may bar my employment. I understand that all information obtained by the Agency regarding any criminal history will remain confidential. I certify that the information on this form contains no willful misrepresentation and that the information given is true and complete to the best of my knowledge.

Applicant Signature*

View Copy of Statement of Employability

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Confidentiality / Conflict of Interest Disclosure Statement

Title: Confidentiality / Conflict of Interest Disclosure Statement

Last Name, First, Middle*

Confidentiality / Non-Disclosure of Company or Patient/Client Information:

Access to any confidential or proprietary information will be limited to the minimum required for the performance of duties as relates to each individual’s job. Any confidential information created, received, maintained, used, disclosed, accessed, or transmitted in the performance of job duties will be maintained and protected from unauthorized disclosure.

The Health Insurance Portability and Accountability Act (HIPAA) ensures the patients’/client’s right to privacy of protected health information (PHI) to be maintained at all times. Any information related to the care of patients/clients through the Agency will be held as confidential. All information, written or verbal, will only be disclosed to appropriate healthcare personnel, staff, those with a “need to know”, or individuals the patient/client requests.

Conflict of Interest Disclosure Statement:

I acknowledge I have read the policy and procedure regarding conflict of interest and the procedure for disclosure. I understand that if I have an outside relationship that is personal, professional, or otherwise, with a patient/client, vendor, or potential business associate, I must disclose the nature of that relationship to my supervisor, or Administrator as soon as the relationship is established. I also understand that I forfeit any voting privileges, decision-making capacity, and input from any activities associated with said relationship.

*

I have no conflict of interest to report.

Applicant Signature*

Confidentiality / Conflict of Interest Disclosure

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Compliance Pledge

Title: Compliance Pledge

Last Name, First, Middle*

The undersigned is a current Governing Body member, owner, officer, director, or person who performs billing or coding functions on behalf of the Agency or an employee of the Agency. In that capacity, the undersigned hereby affirms that:

I have received the Agency Standards of Conduct, have had an opportunity to have questions regarding the Standards of Conduct answered, and agree to conduct myself in accordance with the same in all dealings with or on behalf of the Agency;

I have completed the Compliance Training and Education Program as required by the Agency’s Compliance Program;

I am not aware of any actual or potential unreported activity by any person or entity acting for or in conjunction with the Agency which is known or believed by me to be in violation of any applicable federal or state law, rule, or regulation;

I understand the importance of compliance with applicable laws, rules, and regulations to the Agency, government, and third-party payers;

I understand that all Agency representatives are expected to report any suspected violations of these laws, regulations, or rules to the supervisor or the Compliance Officer. I understand that I must also report any suspected violations of the policies or the standards and procedures of the Program, and that I may anonymously report any suspected violations through the compliance drop box or the hotline number at 817.771.3840.

I understand that conduct in accordance with the Agency’s Compliance Program will be a condition of my continued relationship with the Agency. I understand that failure to comply with the Program may subject me to sanctions or discipline to include, but not be limited to, termination of employment and/or privileges; and

I am not currently, and have not been, subject to any criminal charge or conviction involving any government business nor any conviction, exclusion action, disciplinary action, debarment or proposed debarment, or loss or limitation of licensure, privilege, or employment as a result of any alleged violation of applicable state or federal law, rule, or regulation.

Applicant Signature*

View Copy of Compliance Pledge

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HIPAA-PHI Protection Agreement

Title: HIPAA-PHI Protection Agreement

Last Name, First, Middle*

I plan to utilize electronic documentation of patient/client care.

I will ensure confidentiality and security of patient/client information by password protecting the device or program utilized.

I agree to change the password at least quarterly or following a breach of security.

I will not provide my password to anyone.

I will use an electronic signature, if acceptable to payor source. Authentication will be available if requested by the Agency.

I have been informed of the Agency’s Medical Record Information Confidentiality Policy and Safeguarding Medical Record Content Policy, and I agree to abide by these policies.

I have completed the required training on the Texas Medical Records Privacy Act-Texas Health and Safety Code Chapter 181, Section 181.001 (HB300) concerning protected health information as necessary and appropriate to carry out my duties for the Agency.

Applicant Signature*

View Copy HIPAA-PHI Protection Agreement

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Employee Handbook

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Employee Acknowledgement

Title: Employee Acknowledgement

Last Name, First, Middle*

Confidentiality: The Agency maintains confidentiality of operations, activities, and business affairs of the Agency and the patients/clients according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Texas Medical Records Privacy Act-Texas Health and Safety Code Chapter 181 (HB300). Due to the nature of work, each employee will gain, directly or indirectly, sensitive and confidential information regarding patients/clients and staff members. The healthcare professional safeguards the patient’s/client’s right to privacy by judiciously protecting information of a confidential nature including medical treatment information, diagnosis, medical records, personal patient/client information, etc. This information should be shared only with those persons whom, due to position, have a need to know. Sensitive or confidential information must never be used as the basis for social conversation or gossip. If an employee is in doubt as to whether certain information may be shared, the employee should consult with his or her supervisor.

Drug Testing Policy: The Agency maintains a Drug-Free Workplace Policy with regard to the possession, use, distribution, and sale of drugs or alcohol. All employees are prohibited from the unlawful or unauthorized manufacture, distribution, dispensing, possession, or use of a controlled substance or any alcoholic beverages while in the workplace or on company paid time. Violation of this policy can result in disciplinary action up to and including termination of employment. I acknowledge I have received a copy of the Agency’s policy on drug testing.

Harassment Policy: The Agency is committed to providing a work environment that is free from all forms of discrimination and unlawful harassment including sexual harassment. This policy applies to all employees including management personnel. Sexual harassment is any unwelcome sexual advances, either explicit or implicit, as a term or condition of employment. Improper behavior may be verbal, visual, or physical in nature and/or the creation of a hostile environment. Management will investigate complaints of sexual harassment promptly, impartially, and without fear of retaliation to the employee. An employee should report the alleged incident immediately and confidentially to the appropriate manager or to human resources.

Non-Solicitation/Illegal Remuneration: The Agency does not reimburse or provide incentives to physicians, durable equipment providers, families, or other referral entities for patient/client referrals for home health services. Employees may not solicit patients/clients for the Agency. Employees found in violation of this non-solicitation policy will be subject to discipline up to and including termination of employment.

Non-Discrimination: The Agency does not discriminate against employees based on race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. The employee may file a report of a grievance or complaint regarding discrimination with the Office of Civil Rights within 180 days of when the employee knew of the situation.

Non-Discrimination: The Agency does not discriminate in patient/client provision of services with respect to race, color, national origin (including limited English proficiency and primary language), age, sex (as described in 45 CFR section 92.101(a)(2)), disability, basis of relationship or association, source of payment according to Title VI of the Civil Rights Act or any other characteristic protected by law.

Abuse, Neglect, and Exploitation: Agency employees will report suspected abuse, neglect, and/or exploitation to Agency management and state authorities per policy and regulations. Agency employees suspected of abuse, neglect, or exploitation will be suspended immediately, an investigation will be conducted, and if the investigation validates the claim, the employee will be terminated.

Worker’s Compensation: The Agency is a subscriber to worker’s compensation insurance. An employee who incurs an injury on the job that requires emergency medical treatment or is life threatening should proceed to the nearest emergency room. Emergency medical treatment (non-life threatening) or non-emergency treatment should be referred to the Agency’s designated clinic. Notify the Agency of an injury within 24 hours to complete paperwork. Medical expenses for injuries are covered with the exception of the following: employee’s willful intent to hurt self or others, intoxication or drug use, horseplay, acts of God, and/or acts of a third-party.

Progressive Discipline Policy: The Agency utilizes a progressive discipline process in cases of misconduct or unacceptable performance. This includes a verbal warning, written warning, and final warning. Disciplinary action may begin at an advanced stage of the process or may result in immediate termination based upon the nature and severity of the offense, the employee’s past record, and other circumstances.

Agency Policies: I acknowledge that I have read, understand, and will comply with all applicable agency policies and guidelines.

Applicant Signature*

View Copy of Employee Acknowledgement

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Orientation

Title: Orientation

Last Name, First, Middle*

I acknowledge that I have received access to and reviewed all required orientation materials provided by the agency, including but not limited to policies, procedures, compliance standards, safety protocols, clinical guidelines, and organizational expectations.

I certify that I have completed the agency’s online orientation in its entirety and understand that it is my responsibility to adhere to all applicable federal, state, accreditation, and agency-specific regulations, policies, and procedures.

I understand that completion of orientation does not replace my obligation to seek clarification when needed and to maintain competency within my scope of practice.

To the fullest extent permitted by law, I release and hold harmless the agency, its owners, officers, directors, administrators, employees, and representatives from any liability arising from my failure to follow agency policies, procedures, or regulatory requirements after completion of this orientation.

I acknowledge that my electronic signature below confirms my completion of orientation and serves as my official attestation of understanding and agreement.

Applicant Signature*

View Copy of Orientation Checklist

Orientation

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Hepatitis B Vaccination

Title: Hepatitis B Vaccination

Last Name, First, Middle*

Due to occupational exposure to blood or other potentially infectious materials, you may be at risk for acquiring hepatitis B viral (HBV) infection. The vaccination series is available, at no cost, to you. Please indicate below acceptance or declination to receive the vaccine.

Hepatitis B is a bloodborne virus which can cause a range of symptoms from mild to serious, and possibly result in fatal liver damage to health care workers who become infected. The virus can be transmitted through contact with infectious fluids of a patient who has the hepatitis B virus. You may have been taught the concepts of Universal Precautions concerning safe patient/client care and the use of equipment to avoid unnecessary exposure.

The synthetic hepatitis B vaccine is derived from yeast cells. It is not composed of human blood or plasma. It is given as a series of three injections into the arm muscle at prescribed intervals (initial shot, one month later, and six months later). It has proven to be 80-90% effective in protecting against the disease. There may be hypersensitivity to the vaccine, and there may be soreness and swelling of the injection arm. Other side effects may occur at an incidence of under 3% of injections.

The vaccine will not be given to persons with known sensitivity to aluminum hydroxide, thimerosal, yeast, or the hepatitis antigen, and will only be given with your personal physician’s recommendations in the cases of pregnancy or the presence of other infections of an immunosuppressive state. The vaccine does not grant 100% assurance of immunity.

Acceptance:

I have read the above information describing the risks and benefits of receiving the vaccination. I understand that the decision to receive the vaccination series is mine and I wish to receive the hepatitis B vaccine.

Applicant Signature

Declination:

I have been given the opportunity to be vaccinated for hepatitis B, at no charge to myself. I decline the vaccination series. I understand that by declining this vaccine, I continue to be at risk for acquiring hepatitis B. If I continue to have occupational exposure to blood or other potentially infectious material and decide I want to be vaccinated with hepatitis B vaccine, I may receive the vaccination series at no charge to me.

*

I have already received the hepatitis B vaccine series at an earlier date. Select one:

I am providing a copy of the record to the Agency.

I am not providing a copy of the record to the Agency.

Applicant Signature

View Copy of Hepatitis B Vaccination

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