Name: Signal Health Group
Address: 10475 Crosspoint Blvd, Indianapolis, IN, 46256, US
Telephone: 800-953-6183
Price range: $$

Date
HHA/PCA/HMK Interview Form

Applicant Name:
Applying For:
Full Time	Part Time	Per Diem
Discipline / Department
Tell me a little about yourself ?
Why do you want to work in Home Health Care ?
How would you handle the stress associated with Home Health?
Why do you want this particular job ?
How do you react to change ?
What areas do you feel you would need/like improvement in ?
Describe your organizational skills/time management skills ?
Why are you available for this job?
What is your definition of company loyalty?
How can you be of value to this Agency?
What are your career objectives ?
Where do you want to be in the next five (5) years ?
Applicant Name:
What would you say your clinical strengths are ?
Level of experience? / List Questions Here
Yes	No	Some/little Experience
What areas do you think you need improvement in ?
Describe a difficult/stressful situation you have had in Home Health Care and how did you resolve it?
Describe/Rate your interpersonal skills with:
Peers ?
Doctors ?
Patients ?
Immediate Supervisor?
( IF RN ) how do you describe your communication skills with other disciplines:
LVNs / LPNs ?
Home Health Aides ?
Therapists ?
Describe your work ethic ?
On-call Service Availability ?
Are you familiar with Medicare requirements relative to home care?
Are there any other Home Health Care programs that you familiar with ?
Applicant Name:
FINISH INTERVIEW PROCESS
Go over information about the Agency.
Explanation of benefits after 90 day probationary period.
Interested in this position ?
When to expect a call back from Agency
Go over Salary. / What are your salary requirements ?
OTHER ISSUES OR SPECIAL SITUATIONS THAT WERE DISCUSSED IN THIS INTERVIEW PROCESS?

COMMENTS:
Completed Interview:
Date

HHA/PCA/HMK Interview

HHA/PCA/HMK Interview Form

FINISH INTERVIEW PROCESS