• One Stop Nursing Registry, LLC - Homemaker / Companion Application Packet - DRAFT

    Complete your application packet, availability, and required acknowledgements, and upload the requested documents to submit.
  • Organization: One Stop Nursing Registry, LLC | Address: 13319 SW 135th Ave, Miami, FL 33186 | AHCA License No. 30212618 | Phone: (786) 952-4767

  • Application for Employment

  • Format: (000) 000-0000.
  • Are you 18 years of age or older?*
  • Have you ever been convicted of a felony?*
  • Are you legally eligible to work?*
  • Days Available*
  • Times Available*
  • Available to Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Work Interest
  • Would you like to upload a resume instead of entering education history?*
  • Graduated?
  • Would you like to upload a resume instead of entering former employer history?*
  • From (Month/Year)
     - -
    2 digit month, 2 digit day, 4 digit year
  • To (Month/Year)
     - -
    2 digit month, 2 digit day, 4 digit year

  • Signature and Acknowledgements

  • Authorization Statement

  • By signing, you acknowledge falsified statements are grounds for dismissal, authorize investigation of statements, references, and employers, and that no representative can agree to employment for a specified period unless in writing signed by an authorized representative.
  • Authorization Statement Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Confidentiality Statement

  • By signing, you acknowledge medical records privacy and HIPAA compliance, that patients belong to One Stop Nursing Registry, LLC, and that you will not lure patients away.
  • Confidentiality Statement Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Registration Acknowledgement

  • By signing, you acknowledge the Homemaker/Companion rules: Rule 59A-18.009, Sections 400.506, 408.809, 400.484, 400.462, 408.810(5), Rules 59A-18.018 and 59A-18.005.

  • Registration Acknowledgement Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Hepatitis B Vaccination Declination Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Influenza Vaccination Declination Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Attestation of Compliance with Background Screening - AHCA Form 3100-0008, May 2015

  • By signing, you attest under Sections 435.05(2) and 408.809(2), including disqualifying offenses, any exemption with decision letter attached if applicable, and any prior Level 2 screening in the last 5 years with results attached if applicable. Employer: One Stop Nursing Registry, LLC, AHCA License No. 30212618.
  • AHCA Form 3100-0008 Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Privacy Policy Acknowledgement

  • By signing, you acknowledge the FDLE and FBI privacy policies for the Care Provider Background Screening Clearinghouse, including exchange, retention, and your right to challenge.
  • Privacy Policy Acknowledgement Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Caregiver Agreement 2026

  • This agreement contains all 14 terms, including non-exclusive placement, independent contractor status, self-employment taxes, 1099 over $600 per year, weekly pay, and Florida law. Registry Representative Signature is office-completed after review, not applicant-completed. Registry: One Stop Nursing Registry, LLC, AHCA License No. 30212618.
  • Caregiver Agreement 2026 Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Facility Staffing Addendum

  • This addendum contains all 9 sections, including assignment acceptance, conduct, scope, attendance, facility policies, confidentiality, and non-solicitation for 12 months after your last assignment. Registry Signature is office-completed after review.
  • Facility Staffing Addendum Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Homemaker / Companion Job Description - Homemaker/Companion Health Aide, Reports To: RN

  • Job Title/Position: Homemaker/Companion Health Aide

    Reports To: RN

     

    JOB DESCRIPTION SUMMARY

    The Companion/Homemaker provides companionship to those individuals requiring socialization and/or minimum guidance to assure a protected environment and performs home management services within the client’s home.

     

    ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

    • Provides companionship by reading, conversation, and listening.

    • Does household chores that include housekeeping, cooking, shopping assistance, laundry, and other routine household tasks.

    • Assists patient/client in completing necessary phone calls, letter writing, etc.

    • Maintains a safe home environment for the client.

    • Accompanies patient/client on walks, community trips, doctor’s office, bank, etc.

    • Reminds client to take self-administered medications.

    • Informs staffing coordinator of any changes in assignment.

    • Provides emotional support and promotes a sense of well-being.

     

    This job description is not intended to be all-inclusive. The employee will be expected to perform other reasonable related duties as assigned by management.

     

    POSITION QUALIFICATIONS

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

    EDUCATION AND/OR EXPERIENCE

    High school diploma or general education degree (GED) or equivalent preferred. Training in the topics related to human development and interpersonal relationships, nutrition, shopping, food storage, use of equipment and supplies, planning and organizing of household tasks and principals of cleanliness and safety.

     

    LANGUAGE SKILLS

    Ability to communicate effectively with patient/client, family members, clinical management, and staff. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence.

     

    REASONING ABILITY

    Ability to apply common sense understanding to carry out simple instructions. Ability to deal with simple problems in the home setting.

     

    OTHER SKILLS AND ABILITIES

    Communication skills, light housekeeping skills, cooking, cleaning, and shopping. Good physical and mental health. Caring attitude, tact, patience, and good personal hygiene.

     

    PHYSICAL DEMANDS

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

    WORK ENVIRONMENT

    The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    • Patient home setting, exposure to infectious diseases, automobile.

     

    SIGNATURE DATE

  • Homemaker / Companion Job Description Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • USCIS Form I-9

  • Form I-9 will be completed in the office at your in-person visit. Do not complete it online. The full I-9, employee Section 1 plus employer Section 2, current edition 01/20/25, expires 05/31/2027, is completed in person at the office visit, with Section 2 within 3 business days after the first day of employment after physically examining List A OR List B + List C.

  • Service Area

  • South Miami areas*
  • Can work in South Miami area?*
  • Other service areas
  • Reliable transportation?*

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  • Work Authorization Status*
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  • Hepatitis B Vaccination

  • Mark ONE path: decline now at no charge and you may accept later, OR previously vaccinated and you agree to provide your vaccination record and antibody testing. Never complete both a declination and a record for the same vaccine.

  • Influenza Vaccination

  • By declining, you acknowledge the influenza facts, are declining now, and may change your mind if vaccine is still available. If previously vaccinated, upload the record INSTEAD of the declination, never both.
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  • Hepatitis B Status*
  • Influenza Status*
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