CANDIDATE ASSESSMENT

Damascus Home Care LLC
Augusta, ME
Full Time

Please fill out the Candidate Assessment form below. Reach out to our office if you have any questions at (207) 922-4014

Apply for CANDIDATE ASSESSMENT

First name (required)

Last name (required)

Email address (required)

Phone number (required)

I would like to communicate with the hiring team via text message about my application and next steps.

Address (required)

City (required)

State/Province

Zip/Postal Code (required)

Other Information

Middle Name

Date of Birth

As a home care agency, Dignity Care LLC is required by law to perform a background check. Do you consent to this being completed?

Is there anything you would like to disclose that will show up on a background check?

Why are you looking for a job in the caregiving business?

Are you able to assist with pet care such as cleaning a litter box or walking a dog?

Are you able to transport clients in your vehicle?

Are you comfortable going into a person’s private home alone?

Are you comfortable with pets?

Are you comfortable working in the home of a smoker?

Do you have a valid driver’s license?

Do you have any formal healthcare certifications such as a PSS certificate or higher?

Do you have any physical restrictions that might limit the type of client needs you are able to assist with?

Do you smoke?

Does your vehicle have space to transport a wheelchair?

Do you have reliable transportation with insurance?

Do you have experience with behavioral issues?

Do you have experience with catheter?

Do you have experience with Dementia or Alzheimer’s?

Do you have experience with Diabetic Management?

Do you have experience with Gait belt?

Do you have experience with hospice?

Do you have experience with Hoyer lift?

Do you have experience with incontinence?

Do you have experience with oxygen use?

Are able to assist with home maintenance tasks such as mowing or shoveling?

Are you able to perform light housekeeping duties?

Dignity Care has a contract which covers HIPAA and company policies/procedures. Would you be comfortable signing a contract?

Do you have access to internet at home?

Do you have any experience cooking for someone with special dietary needs (e.g. low sodium, diabetic, food allergies)?

Do you own a smart phone?

How many hours per week are you seeking?

How would you rate your ability to cook meals?

What things are most important to you in the agency at which you are working?

When are you available to start?

Would you be able to have on-call hours?

Please answer "Yes" to all times you are available to work: Friday AM

Please answer "Yes" to all times you are available to work: Friday PM

Please answer "Yes" to all times you are available to work: Friday Overnight

Please answer "Yes" to all times you are available to work: Saturday AM

Please answer "Yes" to all times you are available to work: Saturday PM

Please answer "Yes" to all times you are available to work: Saturday Overnight

Please answer "Yes" to all times you are available to work: Monday AM

Please answer "Yes" to all times you are available to work: Monday PM

Please answer "Yes" to all times you are available to work: Monday Overnight

Please answer "Yes" to all times you are available to work: Sunday AM

Please answer "Yes" to all times you are available to work: Sunday PM

Please answer "Yes" to all times you are available to work: Sunday Overnight

Please answer "Yes" to all times you are available to work: Thursday AM

Please answer "Yes" to all times you are available to work: Thursday PM

Please answer "Yes" to all times you are available to work: Thursday Overnight

Please answer "Yes" to all times you are available to work: Tuesday AM

Please answer "Yes" to all times you are available to work: Tuesday PM

Please answer "Yes" to all times you are available to work: Tuesday Overnight

Have you had CPR training?

Please answer "Yes" to all times you are available to work: Wednesday AM

Please answer "Yes" to all times you are available to work: Wednesday PM

Please answer "Yes" to all times you are available to work: Wednesday Overnight

Please share your physical home address for background check purposes in the following format: Street Name, Street Address, City, State and Zip Code (PO boxes not accepted) .

Please share all previous names you used in the past.

If you have a valid Driver's License, please provide your DL number and state. (This is for your background check) (optional)

Signature and Verification

I certify that answers given herein are true, accurate, and complete to the best of my knowledge. I authorize investigation into all statements I have made on this Form as may be necessary for reaching an employment decision. In the event I am employed, I understand that any false or misleading information I knowingly provided herein or in subsequent interviews may result in discharge and/or legal action. I understand that this Career History Form is not the sole basis from which a hiring decision has been made, and understand that this Form will be used in conjunction with a series of interviews and assessments to determine my suitability for the role to which I am applying.

Signature (required)

AI Usage Notice

This employer may use artificial intelligence (“AI”) to assist in evaluating candidates and making hiring decisions. To the extent the employer is using AI, it will be used to consider the candidate’s fitness for a position. The AI used to assist in evaluating candidates and making hiring decisions will review a candidate’s profile for employer-identified characteristics. The employer is not replacing human decision-making with AI and humans will be reviewing and ultimately making decisions relating to a candidate’s application. As a candidate, you acknowledge and consent to the use of AI by employer in this manner.

By submitting my application, I consent to the collection, storage, and processing of my personal data for the purposes of evaluating my candidacy for employment.

Damascus Home Care LLC