Home Care Services for Chicagoland and the surrounding areas.

CAREERS

Looking for a career that will enrich your life as well as the lives of those you serve? If you have a passion for connecting with and helping others, a career as a caregiver just might be your calling. At Independent Living Home Care, we hire care team members who are honest, hard-working, positive, attentive, professional, compassionate, and spirited. We are an elite team whose common goal is to form relationships with clients and family members to guide the care and services they receive.

All applicants must undergo an extensive background check, as well as a thorough interview and screening process. All caregivers are employed directly by our agency and are insured and bonded to ensure the safety and security of our clients. Once hired, all Independent Living Home Care caregivers are required to complete a pre-employment training as well as ongoing, yearly trainings of a minimum of 15 hours a year to maintain employment.

Health Care Worker Background Check

Disclosure and Authorization for Criminal History Records Check

I hereby authorize the Illinois Department of Public Health (IDPH), IDPH's designee that train or test health care workers, staffing agency, or the health care employer to request a criminal history records check and I further authorize the Illinois State Police (ISP) to release information relative to the existence or non existence of any criminal record which it might have concerning me to the requestor solely to determine my suitability for employment or continued employment. I further authorize any agency which maintains records relating to me to provide same on request to the ISP or IDPH. I certify that the ISP and any agency, including IDPH, their employees or officers who furnish this information shall be held harmless from any and all liability which may be incurred as a result of releasing such information. I further acknowledge that a health care employer shall not be liable for the failure to hire or to retain an applicant or employee who has been convicted of committing or attempting to commit one or more of the offenses stated in the Health Care Worker Background Check Act (225 ILCS 46/25)

I understand that any false statements or omissions on this document may be grounds for disqualification from employment or, if discovered after employment begins, could result in discipline up to and including my termination of employment.

I understand that the information requested below regarding sexy races height, eye color, and date of birth is for the sole purpose of identification and the gathering of the above-mentioned information about me accurately, and that it will not be used to discriminate against me in violation of the law. I understand that the provision of my social security number is required by law. A facsimile or photographic copy of this authorization will be as valid as the original.

First Name* Full Middle Name Last Name* Address* Address Line 2 City* State* Postal Code*

Maiden name (or other name(s) used)

Telephone*

Hair color Gender* Male Female

Date of Birth*

Place of birth *

Height *

Weight * eye color *

social security number *

Race *

Employer Employer's Address Employer's City Employer's State Employer's ZIP Code Date Started Separation Date

Employer Employer's Address Employer's City Employer's State Employer's ZIP Code Date Started Separation Date Other states where you have lived or worked

If the use of alcohol or other drugs was involved in the offense, were you ordered to participate in a rehabilitation program as part of the Judgment? *

Yes No

If yes, you must provide proof of successful completion of the rehabilitation program.

Were you required to pay a fine in connection to a disqualifying offense? *

Yes No

If yes, you must provide proof of having paid all fines unless you are on a payment schedule. If on a payment schedule, you must provide proof that you are up-to- date on the schedule.

If you were released on probation (or mandatory supervised release) or parole, you must provide proof of having successfully completed it.

Have you been certified as a nurse aide/assistant in another state? *

Yes No

If yes, you must attach a copy of your certification or verification information (such as your certification number ).

Have you ever had an administrative finding of abuse, neglect or theft? *

Yes No

If “yes”, indicate in what state this finding was issued:

Have you ever been convicted of a criminal offense, other than a minor traffic violation? *

Yes No

If “yes,” provide the circumstance surrounding each offense (what happened, how many years have passed since the offense, the individuals involved, your age at the time of the offense, and any other circumstances surrounding the offense) as well as the state in which you were convicted. If you have been convicted in another state, you must provide information concerning those convictions or attach the complete results of a criminal history records check from that state. If you have a federal conviction, you must provide information concerning that conviction or attach the complete results of a criminal history records check from the Federal Bureau of Investigation. If more space is needed, please attach additional pages. Do not include convictions that have been expunged, sealed or were a juvenile adjudication.

I certify that the above is true and correct and give my consent for my name to appear on the Department’s Health Care Worker Registry with the results of my criminal history records check: *

SIGNATURE

As the parent or guardian of the above named individual, who is under the age of 17, I give my consent for this named individual to have a criminal history records check.

SIGNATURE

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CAREERS

Health Care Worker Background Check

Disclosure and Authorization for Criminal History Records Check