Employment Application

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It’s an honor to have you as part of our care team at Bloom Homecare. It's our goal to always stay positive and build a relationship together. We believe that each person we care for, is treated with the highest level of Compassion, Dignity and Respect. We are family owned and operated and have been in business since 2006. We understand the importance of teamwork. Each member, including our clients & employees, we consider “family”.  These core values enable our home care to provide quality service on a personal level for our community. Our goal & purpose is to provide you with the best home care experience with us. We have developed a reputation for the care we provide in our community for over 20 years. I stand behind our care and reputation at Bloom & we hope you do too.

Conditional Job Offer

This good faith offer is also conditioned upon the organization's ability to successfully establish eligibility for employment. The eligibility determination is made at the sole discretion of Bloom Homecare and will be based not only on the organization's policy of good moral character and references but also, the information obtained through the mandatory drug screening and background check requirements imposed by the public act 28th of 2006.

This offer is conditional upon the applicants full cooperation with the production of acceptable personal information obtained from signed releases, consent forms, criminal history records, fingerprints and the obtainment of any other information required by policy or law.

Further, I understand that if I quit or am no longer employed in my 90 day probation, or no call no show at any time during my employment, Bloom Homecare will deduct $75 from my last pay check to cover Background check, drug screen, and any other expenses incurred during the employment process. 

Respectfully,
Applicant Full Name
MM slash DD slash YYYY
Address

Uniform Size

Caregiver Skills

Bathing*
Parkinson's Disease Experience*
MS (Multiple Sclerosis) Experience*
Dementia Experience*
Cancer Experience*
Bedbound Experience*
Live In Clients Home*
Transferring Client Bed to Wheelchair
Heavy Lifting*
Foley Cathetar*
Straight Cathetar*
Condom Cathetar*
G Tube Feeding*
J Tube Feeding*
Dressing*
Toileting*
Wound Care*
Hoyer Lift*
Colostomy*

Mobile Upload (NOT NECESSARY)

Bring paper copies to your interview.
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Bloom Homecare Values

"I'm proud to be part of The Bloom Family"

• I build strong relationships and create Bloom clients for life.
• I am always responsive to the expressed and unexpressed wishes and needs of our clients.
• I am empowered to create unique, memorable and personal experiences for our clients.
• I understand my role in achieving The Bloom Homecare Mystique.
• I continuously seek opportunities to innovate and improve The Bloom Senior Care Experience.
• I own and immediately resolve client problems.
• I create a work environment of teamwork and lateral service so that the needs of our clients and each other are met.
• I have the opportunity to continuously learn and grow.
• I am involved in the planning of the work that affects me.
• I am proud of my professional appearance, language, and behavior.
• I protect the privacy and security of our clients, my fellow employees and the company’s confidential information and assets.
• I am responsible for uncompromising levels of cleanliness and creating a safe and accident-free environment.
• I hereby agree to uphold the Values of Bloom

Your Job Description & Offer

Job Positions:

• CNA
• HHA
• Private Care Attendant

Hourly Wage

$16 to $18 Per Hour

Qualifications

• Must be at least 21 years of age.
• Must have a reliable vehicle with proof of insurance & valid drivers license
• Pass a background check.
• Home care experience.

Our Benefits

• We will train the right person! We are entry level so we can get you the experience needed to work in the hospital or in an assisted living.
• Healthcare Reimbursement
• Student Program
• Home care experience.
• Lock Program (Oil Changes, Tire Repairs, 21 Point Inspections, etc. )
• We can be your stepping stone to a better life!
• We offer you W2 employment opposed to contract worker, what this means is you will NOT get a 1099 at the end of the year.
• We offer competitive wages. $16 to $18 per hour
• Discount Care For Your Family
• Paid Bi Weekly via Direct Deposit
• We offer flexible schedules
• We offer you the opportunity to make extra money.
• $50 Bonus referring a new caregiver
• $100 Bonus referring a new client to Bloom Homecare (Call the office to refer a client 248-363-8430)

Our Benefits

• Sign on with us and stay for 1 year
• Receive our annual review
• Show Reliability and Dependability
• Accountable for the clients wellness and care plan
• Raving Client Reviews

Caregiver Post-Employment Non-Solicitation & Conduct Agreement

1. Non-Solicitation of Clients

The Caregiver agrees that, during their employment and for a period of 180 days following termination or discharge, they shall not contact, solicit, or provide direct or indirect services to any current or former client of Affinity Senior Care without the prior written consent of the Company.

This restriction includes, but is not limited to:

• Offering or arranging private caregiving services to any Affinity Senior Care client or their family members.
• Initiating contact with a discharged client with whom the Caregiver had contact while employed.
• Accepting payment or compensation for services provided outside of Affinity Senior Care.

2. Client Protection Policy

To ensure the safety and trust of our clients, the Caregiver acknowledges and agrees:

• If they are no longer employed or are no longer actively scheduled with a client, they must not visit, contact, or travel to the client’s home.
• Any such action may be deemed harassment or a violation of client safety, and Affinity Senior Care reserves the right to notify local authorities and/or pursue legal action to protect our clients and our agency’s integrity.

3. Grounds for Termination

The following behaviors or actions are grounds for immediate termination and may be reported to applicable licensing or law enforcement authorities if necessary:

• Undermining or disrespecting Affinity Senior Care administrators or supervisors.
• Failing to follow chain of command or refusing to report to assigned supervisors.
• Breach of confidentiality regarding clients, staff, or internal operations.
• Arriving to work under the influence of drugs or alcohol.
• Verbal or physical abuse, theft, fraud, or inappropriate conduct in or outside of a client’s home.
• Willful neglect of client duties or falsification of time logs or visit records.
• Repeated call-offs, no-call/no-shows, or unapproved schedule changes with clients.

4. Reporting Schedule Changes

Caregivers are not authorized to independently schedule or reschedule shifts with clients. All changes must go through the Affinity Senior Care office. Failure to comply with this policy is a direct violation of company protocol.


5. Breach Penalty

The Caregiver acknowledges that violation of this agreement—especially direct solicitation or service to former clients—will result in a monetary penalty of $5,000 payable to Affinity Senior Care as liquidated damages, in addition to any legal or equitable relief the Company may pursue.


6. Acknowledgment

By signing this Employment Application, the Caregiver understands and agrees to all terms listed above. Failure to comply may result in disciplinary action, legal proceedings, or criminal charges if warranted by the nature of the violation.


CNA TRAINING

Are you interested to get started?

How much does it cost?

• $650
• Payment Plan Program
  ○ 3 Payments
  ○ Payments are completed by the end of the course. If NOT, No Certificate is granted.

Can Michigan Works Pay for my CNA School Tuition?

• YES. 100% of your Tuition is covered
• Locate your local Michigan WORKS in your city
• Ask About The PATH Program or WIOA Program to qualify
• Mandatory you go in person, we can’t supply the forms for you to enroll
• It can take up to 2-3 Weeks to become eligible
• It can be delayed if you don’t provide them with everything they need
• Once you’re approved. Choose Dreamers Healthcare Institute as your preferred school
• Michigan WORKS will contact Dreamers upon your approval.
• You will hear from Dreamers after they are contacted by Michigan WORKS

Affinity Guidelines & Expectations

Our care plan follows the ADL Home Care standards to receive the best experience while under our Affinity care.

Your Daily Tasks Performed at Affinity

Physical Activity

Lifting & Transferring

• Transfer of clients who can bear weight on legs, assistance with walking, outings.

Physical/occupational therapy : We can give clients reminders to complete exercises and stand by to assist with balance.
• Standby assist/light transfer
• Partial assist/medium transfer
• Full Assist/High Transfer

For non-weight bearing clients :

• Bed rest care
• Lift/transfer with Hoyer, side boards, sit to stand lift
• Two-person transfer
• For clients > 180 lbs with no upper body mobility or severe dementia: consider two-person lift.

Companionship

• Conversation, activities, attending functions, and supporting hobbies.

Meals & Groceries

Meal preparation or cooking involving simple recipes, assistance with eating.

• Clean-up and grocery shopping.
• Specialty diets require simple plans to follow.

Personal Care

Assistance with personal hygiene, changing briefs and pads, bathing/showering.

• Grooming: oral care, using electric shavers, assistance with dressing and nail filing.
• Emptying colostomy bags and draining catheter bags
• Applying or changing condom catheters
• Providing care for bedbound clients with assistive equipment.

Wound Care

Rinsing of minor cuts/scrapes with soap and water.

• Grooming: oral care, using electric shavers, assistance with dressing and nail filing.
• Changing band-aids for a minor cuts/scrapes.
• Apply OTC barrier creams/lotions on closed skin following instructions
• CPs can loosely secure a bandage that was already in place to prevent client injury or exposure to wound drainage.

Light Housekeeping

• Light housekeeping. Including cleaning dishes, helping with laundry, tidying rooms, removing trash, cleaning counters.

Transportation

Provide client transportation to doctor’s appointments, PT/OT/cardiac rehab, groceries, errands, social events, etc.

• CPs can drive their own or client’s car. CP can transport weight bearing clients who need a wheelchair. CP can run errands on her own if client can be left unattended.
• Ride-share or professional driving service can be used for transport

Medication Reminders

Medication (OTC and prescription) reminders:

• Care Pros can assist with self-administered medications using “guided hand” technique.
• All oral medications need to be prepped and placed in a mediset/bubble pack that is properly labeled with the date/time due for a care professional to help with hand-guided delivery.
• CPs can “hand guide” oral liquid meds but client must be strong enough to push the plunger to dispense medication independently. All liquid medication needs to be pre-measured.
• The following applies for PRN (as needed) medications: : If a client is alert and oriented with no memory care condition, CPs can provide normal assistance with self administration based on the client’s request to the Care Pro.
• Medication patches: CP can assist client with opening of packages and applying patches through guided hand technique. CP needs to remind client to remove old patch before the new one is applied. Patches need to be date and time stamps. CPs are required to wear gloves when touching medicated patches. If AO leaves pre-filled liquid meds or pre mixes meds in food, Care Pro can assist client with self-administration.
• Medicinal Marijuana : Same as other medications where legal.
• Oxygen
• C-pap or breathing machines/nebulizer independently/using guided hand technique.
• Vital measurement : assist client with self measurement of vitals on electronic machines and record results.

Facility Care

Assisted/Independent Living : ADL/personal care support.

• Hospital/Skilled Nursing Facility : Generally sitting services only. Personal care support is based on medical facilities policies.

Dementia

• Mild, Moderate or Severe Cognitive Impairment.

Unsafe Environments

• Safety is a priority. Reassessment may be needed to ensure safe working space.

Pet Care

CP can assist with picking up pet feces and feeding pets no more than twice a day.

• CP can assist with walking pets with client.
• Pet care must be incidental and cannot be primary purpose of services.

Consent For Random Drug / Alcohol Testing

Authorization For Release Of Information
I hereby agree to submit to random urine drug/alcohol testing as part of my hiring requirements to help ensure the safety and well being of Affinity Senior Care, Clients, Patients, Employees, staff and or/other parties.
I understand that Affinity Senior Care may ask me to submit such test at any time during my employment and I giving my consent to comply with such request(s).
I am aware that the results of these random drug/alcohol tests will be utilized to help determine my ability to provide a safe environment for Affinity Senior Care Clients, Patients, Staff and or/ other parties.
I authorize my sample from the random urine/drug test to be sent out to a labratory for screening to determine the presence of any prohibited substances. I further authorize the labratory or ther testing facility to release or disclose any and all documentation relating to the test results to Affinity Senior Care. The results will not be disclosed to any other third party. The results will be used for the benefit of Affinity Senior Care only.
To continue my employment with Affinity Senior Care, it is my responsibility to report any status changes in regards to my criminal background, I have also been informed and am willing to comply with all Drug Screening Policy- of Affinity Senior Care. As a term of my employment, I understand that it’s my obligation to have a negative drug screening results.
I understand that the authorization of this disclocure of health information is voluntary and I can refuse to sign this authorization.
Clear Signature
MM slash DD slash YYYY

Background Check Authorization

After carefully reading this Background Check Disclosure and Authorization form, I authorize the Affinity Senior Care to order my background report, including investigative consumer reports. I understand that the Affinity Senior Care may rely on this authorization to order additional background reports, including investigative consumer reports, during my employment without asking me for my authorization again as allowed by law. I also authorize the following agencies and entities to disclose to the Background Check I CHAT and its agents all information about or concerning me, including but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; if applicable, worker’s compensation injuries; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. Workers’ compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or any other applicable federal, state or local laws and only after a conditional job offer is made. The information that can be disclosed to the Background Check Company and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses and substance abuse testing.
I agree the Affinity Senior Care may rely on this authorization to order background reports, including investigative consumer reports, from companies other than the Background Check Company without asking me for my authorization again as allowed by law. I also agree that a copy of this form is valid like the signed original. I certify that all of the personal information I provided is true and correct.
To continue my employment with Affinity Senior Care, it is my responsibility to report any status changes in regards to my criminal background, I have also been informed and am willing to comply with all Drug Screening Policy- of Affinity Senior Care. As a term of my employment, I understand that it’s my obligation to have a negative drug screening results.
I agree the Affinity Senior Care may rely on this authorization to order background reports information I provided is true and correct.
Clear Signature
MM slash DD slash YYYY

Reference Check

New Applicant Name
I authurize and give permission to the following contact below to provide employment references to Affinity Senior Care.
Last Employers Name
Clear Signature
MM slash DD slash YYYY

Quick Inquiry

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