Forms and Engagement

Employee Physical Exam Form

At J&N Exquisite Homecare Inc. , the health and safety of both our employees and clients are our top priorities. To maintain the highest standards of care, we require all potential caregivers to undergo a thorough pre-employment physical examination using our Employee Physical Examination Form. This detailed form ensures that every employee is physically, mentally, and emotionally fit to provide direct patient care in home settings.

Employee Application Form

This document is the Employment Application Form for J&N Exquisite Homecare Inc., an equal opportunity employer. It is designed to gather comprehensive information from job applicants seeking positions in the home care industry. The form collects personal details (name, address, contact information), employment eligibility, education and training history (including certifications like CHHA, CNA, RN, or LPN), work experience, references, and additional skills relevant to caregiving roles.

Applicants must also disclose any gaps in employment, provide consent for background checks, and authorize the release of prior employment information. The form includes sections for CPR certification, malpractice insurance (if applicable), and a statement acknowledging that employment is "at-will" and contingent upon meeting health requirements, providing proof of identity, and passing a criminal background check. This thorough application process ensures that only qualified and trustworthy individuals are considered for caregiving positions.

Health Self-Assessment

This document is the Health Self-Assessment Form for J&N Exquisite Homecare Inc. , designed to evaluate the health status of individuals providing care to vulnerable populations. The form begins with a general assessment of the individual’s overall health, allowing them to rate their condition as excellent, very good, good, fair, or poor.

The next section focuses on preventative health measures, asking whether the individual has received key vaccinations, including COVID-19, flu, MMR (measles, mumps, rubella), and Hepatitis B, along with dates of immunization.

The final section addresses job requirements and responsibilities, prompting the individual to confirm their ability to fulfill the duties outlined in the job description. If accommodations are needed, the form requests a description of the required support and medical documentation to substantiate the request.

This self-assessment ensures that caregivers are up-to-date on essential health precautions and capable of performing their roles effectively while safeguarding the well-being of clients.

Reference Form - Employment

This document is the Employee Reference Request Form for J&N Exquisite Homecare Inc., designed to gather feedback from previous employers to evaluate an applicant’s suitability for a position in the home care industry. The form requests detailed information about the applicant’s employment history, including dates of employment, positions held, and reasons for leaving. It also includes an evaluation section where the previous employer rates the applicant on key performance areas such as attendance, punctuality, dependability, quality of work, job knowledge, and attitude.

The form ensures confidentiality and requires the applicant’s consent to release employment-related information. Additionally, it asks whether the applicant would be rehired and provides space for additional comments or clarification if discrepancies arise. This thorough reference check helps verify the accuracy of the applicant’s claims and assesses their reliability and compatibility with the role they are applying for.