• One Stop Nursing Registry, LLC - Home Health Aide (HHA) 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
  • 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.
  • Signature and Acknowledgements

  • 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.
  • Authorization Statement Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Registration Acknowledgement

  • By signing, you acknowledge the CNA/HHA rules: Rules 59A-18.005, 59A-18.0081, Sections 400.506, 408.809, 400.484, 400.462, 400.488, 408.810(5), Rule 59A-18.018.
  • Confidentiality Statement Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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.
  • 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.
  • 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.
  • Privacy Policy Acknowledgement Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • HHA Job Description - Reports To: RN

  • Job Title/Position: Home Health Aide

    Reports To: RN

    JOB DESCRIPTION SUMMARY

    The home health aide is a paraprofessional member of the home care team who works under the supervision of a registered nurse and performs various personal care services as necessary to meet the client’s needs. The home health aide is responsible for observing clients, reporting these observations and documenting observations and care performed.

    The home health aide will be assigned in a manner that promotes quality, continuity and safety of a client’s care.

    ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

    Responsibilities of the home health aide include, but are not limited to, the following:

    1. Providing personal care including:

    A. Baths

    B. Back rubs

    C. Oral hygiene

    D. Shampoos

    E. Changing bed linen

    F. Assisting clients with dressing and undressing

    G. Skin care to prevent breakdown

    H. Assisting the client with toileting activities

    I. Keeping client’s living area clean and orderly, as appropriate

    2. Planning and preparing nutritious meals.

    3. Assisting in feeding the client, if necessary.

    4. Taking and recording oral, rectal and axillary temperatures, pulse, respiration and blood pressure when ordered (with appropriate completed/demonstrated skills competency).

    5. Assisting in ambulation and exercise according to the plan of care.

    6. Performing range of motion and other simple procedures as an extensional therapy service as ordered (with appropriate completed/demonstrated skills competency).

    7. Assisting client in the self-administration of medication.

    8. Doing client’s laundry, as appropriate.

    9. Meeting safety needs of clients and using equipment safely and properly (foot stools, side rails, etc.).

    10. Reporting on client’s condition and significant changes to the assigned nurse.

    11. Adhering to the Organization's documentation and care procedures and standards of personal and professional conduct.

    The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.

    POSITION QUALIFICATIONS

    1. Meets the training requirements in accordance with State and Federal laws.

    2. At least 18 years of age.

    3. Ability to read and follow written instructions and document care given.

    4. Self-directing with the ability to work with little direct supervision.

    5. Empathy for the needs of the ill, injured, frail and the impaired.

    6. Possess and maintains current CPR certification.

    7. Demonstrates tact, patience and good personal hygiene.

    8. Licensed driver with automobile that is insured in accordance with Organization requirements and is in good working order.

    10. Has excellent observation, verbal and written communication skills. Will be required to communicate with RN, clients and client’s family members when necessary.

    11. May occasionally have to lift patients/clients if necessary.

    {Note: Effective August 14, 1990, a person who has successfully completed a state established or other training program that meets the requirements of CFR 484.36(a) and a competency evaluation program, or state licensure program that meets the requirements of CFR 484.36(b), or a competency evaluation program or state licensure program that meets the requirements of S 484.36(b).}

    JOB LIMITATIONS

    The home health aide will not function in any manner viewed as the practice of nursing according to the State's Nurse Practice Act. Specifically, the home health aide will not administer medications, take physician's orders or perform procedures requiring the training, knowledge and skill of a nurse, such as sterile techniques.

    SIGNATURE DATE

  • Caregiver Agreement 2026 Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Facility Staffing Addendum Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • HHA 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?*
  • Required Uploads

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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.
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  • 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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