Happy Health Services                              vs95 180807
employment application

 I agree that the person filling in the form, and the person indicated above are the same person.   I understand all the duties and tasks related to PCA work for Happy Health Services, and I am both willing and able to perform all the required tasks when needed, or I will make sure I completely understand the tasks required before accepting employment.   After my training and orientation I will notify the agency of any tasks I am unable or unwilling to do as a PCA, and have those duties exempted for me in writing from the personnel office before beginning employment.  Exemptions from any PCA duties of any kind are at the desecration of the agency.   I have no physical impairments that will prohibit my ability to work as a PCA or lift normally.  I understand I will not let personality differences interfere with my client duties, and I am both willing and able to work around cats, dogs, and people who smoke when necessary.  I agree to provide my own transportation to and from my work locations at my own expense by way of automobile by the quickest route possible, and at my own personal liability.  I agree to maintain and insure said transportation as needed in accordance with all applicable company rules, state laws, and federal laws.  I understand at any time I am unable to provide myself the needed transportation, my employment may be temporarily or permanently suspended with no financial benefit of any kind payable to me.  I understand to be able and willing to work, or to accept available work, I must be willing and able to travel one way 15 miles until closer work with the hours desired can be can be arranged.   I agree to comply with all State, Medicaid  and company requirements for maintaining current compliance for training, TB, CPR and processing of time records.  I understand maintaining these requirements is my responsibility.  I understand failing to submit time records in the time and method required, or failing to maintain current compliance with all employee requirements means I may not be paid for services provided, and it is my responsibility to understand the correct procedure.   I understand I will only be paid for services authorized on the approved schedule by the agency, and it is my responsibility to know my schedule.   

     I agree to follow the agency requirements for seeking work, or it will be considered that I am not seeking additional work, but choosing not to work, or work only part time.   I understand I must call the office at least twice weekly during posted business hours, and request my call be documented if I am seeking work.  I understand it is my responsibility to know and understand the current company policies and procedures for compliance and seeking work, and have it explained to me when needed.  I understand it is my responsibility to confirm and document with the agency when I return to work from personal leave of absence or other leave.   I understand failure to return from any leave of absence as required, failure to communicate as required with the agency, or failure to seek or accept work for 30 days or more may lead to my suspension from employment, or require me to redo some or all of the initial pre hire training.  Failure to discuss, resolve, or get resolutions to suspension for 30 days or more from the agency, may result in termination of employment or deactivation from the eligible work roster.  I understand I must maintain the ability to be reachable by phone for the purpose of scheduling when appropriate. 

     Females have the right to reasonable accommodation of condition related to pregnancy, childbirth or related condition.  Use online LOA form as FMLA to take leave from work if needed or desired.

     I understand failing to report hospitalizations or missed services of my client immediately, or submitting time records for services not provided by approved and verifiable methods, my result in termination, immediate loss of direct deposit privileges, conviction, and recoupment of any funds paid to the PCA.

      I agree to use the agency electronic communications methods on the agency website currently referred to as (message) for updates on policy and procedures changes, work rules, pay related issues, direct deposit changes, and all related job matters.  I agree to follow the policy for reviewing the website on schedule for changes and updates in policy, and follow the posted polices.  I understand failure to view or understand posted changes will not exempt me from the responsibility to follow and be subject to posted rules and changes.  I understand I am required to view the message board bi weekly as described on the PCA signature page, and use the office computer if other access is unavailable to me.   

I have no convictions,  and no pending or current charges for items pursuant to  Nevada Revised Statutes NRS 449.123.  I have no felony conviction record.  I have no past or pending charges or convictions related to these statues or listed in NRS 449.174.  If I should be charged or convicted on any of the items described in these statutes after completing this application, I will notify the agency legal department immediately and be subject to termination.  I understand my employment is provisional upon meeting the background requirement, and any new or discovered charges not resolved within 30 days, or background convictions under NRS 449.123 or items listed in 449.174 during the course of my employment will be considered willful and deliberate misconduct and violation of my employment agreement, and my result in termination.  The agency may ask me to complete a new background check at any time to confirm my compliance with the rules, and, or, the accuracy of my statements concerning my background. I will accept DPS results on my background search as being final and correct for the purpose of this employment, and it is my responsibility to have the record challenged with DPS if necessary.  It is my responsibility to understand and review my past and current record, and speak to the agency legal department if I have any doubts concerning qualifications under the statute. 

     I understand employment requires an electronic personal use device that can be used for web access and communication when working with clients.  I will maintain this device in operating order at all times of employment activity.   I agree to use the device for web accesses when deemed necessary by the agency.  I understand this device is my personal device to be operated and maintained at my expense unless I choose to make  arrangements with the agency for the procedure to use when such a device is not available to me, or if I choose not to own or maintain such a device.

     I understand prior to employment, and before being hired, I must have Tb, cpr, physical, and 16 hours of basic training that comply with agency rules of compliance.

     I understand the agency may assist me in acquiring the items needed for employment, but I will not be considered hired unless all requirements are met,  the agency has given me a specific job assignment, and I have accepted and begun a work assignment.   Attending training classes, or getting other assistance from the agency, will not mean I have been hired by the agency.  When currently employed, travel time to a client, and cost of maintaining compliance with not be compensated separately, but is part of hourly compensation paid for client service when legally required. 

      I have read and understood this agreement , or had it explained to me.  I have read and understood the payday direct deposit rules in the help box below.  I will only submit this document when accurate and understood by me.  I understand submission of this document is not a secured process, and  security of the submission is the responsibility of the applicant.

Do you have a complete two step tb, physical, and cpr training.  If not, return to this application when the requirements are complete. (CPR cannot be done online and must be verifiable).   Two step tb requires 4 visits and two shots as approved methods at this time for hhs.  Consult office to confirm you are getting the correct test for tb.  
     PCA,s are required to have compliance items in place prior to employment.  Any items for compliance required after the PCA has begun work and been hired, will be completed with a referral to the vendors of Happy Health Services for discounted prices, which may then be deducted from future income.  If the employee chooses to get compliance items from other sources, they will accept the responsibility for any added cost, and will be responsible to meet the compliance standard.
     If a client is waiting for you to complete your requirements, or if you have been instructed to complete the application now, then you may click NO, complete the application, and call the office when done as instructed.  Office 702-257-9638 (read help) * 🛈
Do we currently have a client waiting for you to complete your process *
Paycheck Data Online *
Direct deposit terms and conditions read and understand help * 🛈
have you ever filed or collected on a workman's comp claim *
Does your injury affect you physical ability performing PCA Services? *
Have your ever worked for Happy Health Services or New World Associates Inc in the past *

Personal Information


do you have a properly regestered and insured vehicle to drive to work sites *

Employment History




Additional Skills

do you have any significant office software or computer skills *
Days Available *
software use experience or write none *
Signature of Applicant: (Missing signature does not invalidate this document) *

The sender takes responsibility for the security of the computer used to send data, and understands the agency is not responsible for the security or content of information sent through the internet.