Step 1Step 2Step 3Step 4 Name of Applicant: Date: Position Applied for: Have you ever worked for Prime Home Health Services? YesNo If yes, what was your reason for leaving? Please tell us how you heard about Prime Home Health Services Internet AdNewspaper AdMagazine AdFriendPRIME HHS EmployeeJob FairOther Next Application for Employment Employer's Statement Please print clearly. This application must be completed and all the questions regarding your training and work experience must be answered. All information on this application is confidential, Prime Home Health Services LLC. will not contact your present employer without your consent. In accordance with federal, state, and local laws, Prime Home Health Services LLC. does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, age, disability, or any other legally protected status. Applicants may request any reasonable accommodation to participate in the application process. Name: (Last) (First) (Middle Initial) Other Name if Applicable: Address: Length of time at this address City/State/Zip: Home Phone: Mobile: Fax: Position Applied for: Date: Education School, City, and State of School # of YearsCompleted Degree/Diploma/Certification Graduated?Yes or No Major Course of Study Professional Licenses and/or Certificates TypeCPR, PT, RN, HHA, CNA etc. Agency/State Issued Date Issued Expiration Date Lic Number *Office Use Only*Enter date and Initials of person verifying Do you have a Valid Driver’s License? YesNo Do you have access to a vehicle? YesNo Do you have experience working on the computer? YesNo *Please begin with your most recent employment and proceed back to at least 10 years of Employment History Employment History Employer: Supervisor’s Name: Address: Phone: From: (mo/yr) To: (mo/yr) Starting Position: Final Position: Reason for Leaving: Employment History Employer: Supervisor’s Name: Address: Phone: From: (mo/yr) To: (mo/yr) Starting Position: Final Position: Reason for Leaving: Employment History Employer: Supervisor’s Name: Address: Phone: From: (mo/yr) To: (mo/yr) Starting Position: Final Position: Reason for Leaving: Which Zip Codes are you available to work in? Please indicate your Primary Language: Please indicate any other Languages spoken: PreviousNext Applicant’s Statement I hereby affirm that the information provided on this application) and accompanying resume, if any) is true and complete to the best of my knowledge. I also understand and agree that any falsified information or significant omissions may disqualify me from further consideration for employment and, if discovered after 1 am hired, may result in dismissal.I also understand that id employment is offered and accepted such employment is not for any specified term and can be terminated at anytime, with or without cause, either by Prime HHS or me. I further understand that this application is not a contract of continued employment, and that my at-will employment status cannot be changed.In consideration of my being considered for employment, I authorize a thorough investigation of my past employment and activities. I agree to cooperate in such investigation, and release from all liability all persons and businesses requesting or supplying such information.I understand that Prime requires that a Criminal History Check be conducted on persons to whom an offer of employment is made, if the person's duties will involve any direct patient contact, including telecommunications, with any patient, patient's family, or patient's visitors, or the property of such persons. I also acknowledge that Prime requires a Drug Screening to be conducted on persons to whom an offer of emp loyment is made,By signing this application, I acknowledge that I have been informed by prime HHS that a criminal history check will be performed along with a Drug Screening. I have informed Prime HHS of all names, (i.e., maiden, aliases) that I have used in the past. I understand that I may be employed on an emergency basis and that my employment mav be temporarv pending the results of mv criminal history check and Driio Screening, Signature: Date: ***** OFFICE USE ONLY ***** Starting Date: Title: PreviousNext Computer Skills Assessment Name: Date: **Please rate yourself as a computer user by indicating the appropriate level** Function Beginner Skilled Proficient Turn on a computer Beginner Skilled Proficient Knowledge of a keyboard Beginner Skilled Proficient Working with a mouse Beginner Skilled Proficient Functions of the computer screen Beginner Skilled Proficient Using Icons and Creating desktop shortcuts Beginner Skilled Proficient Accessing features using the start button Beginner Skilled Proficient Accessing features using the start button Beginner Skilled Proficient Working with multiple programs by using the taskbar Beginner Skilled Proficient Use of the My Computer Icon to access the drives Beginner Skilled Proficient Using Microsoft Outlook for emails Beginner Skilled Proficient Reading, composing and sending emails in Microsoft Outlook Beginner Skilled Proficient Responding and forwarding emails in Microsoft Outlook Beginner Skilled Proficient Using Internet Explorer Beginner Skilled Proficient Use of the Recycle Bin Beginner Skilled Proficient Copying and Pasting sections of text Beginner Skilled Proficient Opening and closing programs Beginner Skilled Proficient Customizing the computer desktop Beginner Skilled Proficient Using keyboard shortcuts Beginner Skilled Proficient Creating a Microsoft Word document Beginner Skilled Proficient Shutting down or logging off from the computer Beginner Skilled Proficient Please circle the correct answer. 1. To boot up a computer means to: a) Turn it on and get it startedb) Test a computer's compatibilityc) select an operating systemd) remove all data from the hard drive 2. An icon on a computer screen is a (n): a) Desktop areab) File from a folderc) pictorial representationd) directory 3. What general term describes the physical equipment of a computer system, such as its video screen, keyboard, and storage devices? a) Hardwareb) Softwarec) inputd) output 4. What is a small, hand-held device that is used to move the cursor to a specific location on the screen? a) A mouseb) A frogc) a keypadd) a message pad 5. Which of these is not safe near a computer and its peripherals? a) Eating and drinkingb) Turning on a lampc) writing with a pencild) storing papers in folders 6. Hard Copy is another term for a: a) Second copy of the hard disk driveb) Copy printed on cardstockc) printoutd) page layout on screen 7. Which key moves the cursor to the beginning of the next line of text? a) Shiftb) Enter/returnc) tabd) backspace/delete 8. What is most commonly used to enter text into a word processing program? a) Keyboardb) Mousec) printerd) monitor 9. Raymond has typed a story for the school's literary contest and realizes that he has left out a very important paragraph. Which of the following would be the most efficient thing to do? a) Type the needed text at the end of the paper and use the ’Move’ command to place the paragraph at the proper locationb) Place his cursor where he needs to type that paragraph and type the needed textc) Type the needed text in a new document and use the “Copy” command to place the paragraph at the needed locationd) Place the cursor at the beginning of the story, type the needed text, and use the “Move” command to place the paragraph at the proper location 10. Brian has created a ten-page story, but only wants to print the first two pages. What printer command should he select? a) From_____to_____b) Print allc) print alld) page setup 11. Jim is typing a song on his word processor. The song has four verses, and the chorus is repeated after each verse. What would be the most efficient way to enter the song, making sure the chorus is repeated after each verse? a) Type the chorus four timesb) Copy the chorus on a copy machine and then cut and paste it into his documentc) Use the copy/paste command on his word processord) Highlight the text and change it to Bold 12. Which of the following is an example of an e-mail address? a) www.yahoo.comb) doejobq@mucohio.educ) Jon Q. Doed) doejobq 13. After receiving an e-mail you can: a) Reply to the sender and read itb) Forward it to others and delete itc) Edit it and save itd) All of the above 14. When you are instructed to "point and click," it means you: a) Use the mouse to move the pointer around the screen and then click the mouseb) Select the objectc) Use the mouse to move the pointer around the screen and then press the space bard) Double-click the mouse 15. "Desktop" is a computer term that refers to: a) The part of your work area where the computer monitor sitsb) Something that can and should be ignored by most usersc) The list of all the contents on a particular computerd) The initial screen showing icons for folders, files, and applications 16. What is the proper procedure for shutting down your computer a) Whenever you’re ready to quit, simply push the lighted button on the tower, r the power buttonb) Go to the Start menu and click "Shut down"c) It’s best never to turn off your computer Previous
