I Am Unique Special Care and Case Management, Inc.

Nursing Opportunities

Name:
Category:	RN LPN CNA
Date:
Phone (Day):
(Evening):
(Pager):
Address:
Referral	By Client By Employee
Name:
Other:
Have you applied with us before?	Yes No
Experience: How many years?

Agency	Home Health	Private Duty	Hospital
Nursing Home	Vent Exp.	G-Tube	Trach
Adult	Pediatric	Other (Please mention briefly in Comments Box)

Availability:		Date available to start:
Schedule Preferences:

Days:	Monday	Tuesday	Wednesday
	Thursday	Friday	Saturday	Sunday

Shifts:	7 am - 3 pm 3 pm - 11 pm 11 pm - 7 am 7 am - 7 pm 7 pm - 7 am
Flexibility:	Yes No

Dependable Transportation?	Yes No
Comments:

Applicant must bring the following documentation to their interview:

•	Current Nursing License
•	Current Driver's License
•	Social Security Card
•	Current CPR Card
•	TB Record (Annual) or Chest X-Ray (Every 2 Years)

Applicant must have the following completed prior to employment:

• Health Exam Questionaire

• OSHA/Bloodborne Pathogens/Infection Control Review

• Back Safety or Body Mechanics Review

• Fire Safety Review

• Drug and Alcohol Screening

• Criminal Background Check

The information which you give in completing this form will be forwarded to the designated party for its use and will not be used by Real Pages for any other purpose or provided by us to any other parties. If you wish information concerning the privacy policy or the designated recipient, you should contact them directly.

I Am Unique Special Care and Case Management

We assure quality through In-Home Training,
Inservice Education and Team Nursing.

Educational Modules

A.	In-Home Orientation
B.	OSHA: Communicable Diseases, Fire Safety, Slips, Trips, and Falls, Back Safety
C.	Home Etiquette
D.	Team Managed Care
E.	Special Care Equipment, i.e., Beds/Hoyers/Etc.
F.	Trach Care/Trach Change/Suctioning Technician
G.	Ventilator - Equipment
H.	Ventilator - Nursing Care
I.	G Tube/Care/Replacement/Other Devices
J.	IV Nursing Care in Home
K.	Additional audio and video education available for advancement of skills, personal and spiritual growth.

Employee Ownership Works

Office Hours: Monday - Friday 8:30 am - 5:00 pm

I Am Unique
Special Care and Case Management
3211 Bramer Dr. • Suite F • Raleigh, NC 27604
(919) 981-0790 • (800) 566-8648 • Fax: (919) 981-0135
E-Mail Us at: ahines@btitelecom.net

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