Dear Candidate,

We value our employees and we treat them like family. Each team member can take advantage of our ongoing training programs, advancement opportunities and progressive culture. We strive to make the application process as easy and convenient as possible. Before you start this application please gather:

  • Documents and digital copies of your certifications
  • Your personal details, SSN, driver's license
  • Past employment history
  • Professional references

You may scroll through the page to see what information is required.

Required Documents

Please upload the following documents in the Upload Documents Area:

  • Copy of Professional License
  • Copy of CPR Certificate
  • Copy of Social Security Card
  • Copy of Driver's License
  • Copy of Auto Insurance
  • Copy of Chest X-ray (valid 5 years) or TB test (valid 1 year)
  • Copy of Annual physical exam (within last 6 months)
  • (Optional) Copy of Phlebotomy Technician Certification
Click or drag files to this area to upload. You can upload up to 10 files.
Please click above to upload pictures in .jpg, .jpeg or .png format or PDF versions of your documents.

Applicant Information

//

Position

//

//

Education

Emergency Contact

If known

Professional References



Former Employers

Please provide your most recent positions of employment.
From Date - To Date

From Date - To Date

Applicant Statement


I certified that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I understand that any offer of employment I receive may be contingent on passing a job-related physical examination, and/or satisfactory completion of a background examination.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations and organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard, from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I free to resign at any time, with or without cause, and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without, cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement and contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that any information provided by me that is found to be false, incomplete or misrepresented in my respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

I authorize Infinite Home Health and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references, drug testing, civil and criminal history records from any criminal justice agency in and or all federal, state, country jurisdictions; driving records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any all information, verbal or written, pertaining to me, to Infinite Home Health or its agents. I further authorize, the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

I hereby release Infinite Home Health, the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family or associates because of compliance with this authorization and request to release.

I certify that I have read, fully understand, and accept all terms of the forgoing Applicant Statement.

CPR Mask Acknowledgment


I acknowledge that I will get a CPR mask from Infinite Home Health, Inc. If I use the mask, I am to alert Infinite Home Health, Inc., so that it may be replaced. If I lose the mask, I am responsible for the cost of a replacement mask. I understand that the mask should be with me on all visits to patient homes.

Hepatitis Vaccine Policy


The center of Disease Control (CDC) and Occupational Safety and Health Administration (OSHA) recommend immunization for all healthcare workers in the high-risk category. As healthcare personnel who will be expressed to the patients’ blood and body fluid, you will fall into this high- risk category.

The CDC Immunization Practices Advisory Committee recommends that if you are NOT vaccinated, you should receive one dose of Hepatitis Immune Globulin Human (HBIG) and begin a series of Hepatitis B Virus (HBV) vaccine.

I, the undersigned, have been offered the opportunity to receive a Hepatitis B Vaccination, free of charge as an employment benefit provided by Infinite Home Health, Inc.

I have read the above statement and I am aware that if unvaccinated, I am at risk of contracting Hepatitis B during employment.

Patient Records State Mandate Compliance


Title 22 of California Code of Regulations, Division 5, Chapter 6, is the California Law that governs all HOME HEALTH AGENCIES. Section 74735, Patient Health Records Paragraph (5) states “CLINICAL NOTES SHALL BE SIGNED AND INCORPORATED INTO THE PATIENT’S HEALTH RECORD AT LEAST EVERY SEVEN (7) WORKING DAYS”.

All Infinite Home Health Inc. clinicians must comply with this state Mandate. The agency will require all clinicians to submit the patient visit notes with five (5) days of the visit date, and no later than 5:00 P.M. on Monday. There will be no exceptions.

Note: Notes that incomplete, missing signature(s), or need clarification will be returned to the clinician For corrections. Therefore, clinicians must submit their notes in a timely manner to allow for interview, corrections, final completion and filing into patient’s charts, so that both the clinicians and the Agency remain compliant with the STATE REGULATIONS.

Thanking you in advance for your cooperation,

Zahra Bidari, RN
Clinical Supervisor



I certify that I have read and understand all of the above information.

//