Fee For Service Social Worker (Manhattan)

Certified Home Health Agency - Bronx, NY

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Additional Information

Criminal History

Are you 18 years or older?
If under 18 years of age, do you have a work permit? If you are over 18, please type N/A
Have you ever been employed by The New Jewish Home?
If yes, please list the position and dates of employment. If no, please type No.
Please list the names of any relatives employed by The New Jewish Home. If none, please type None.
Are you currently licensed in New York State for your profession?
How many years experience do you have?

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Voluntary Self-Identification

Jewish Home Lifecare is an Equal Employment Opportunity Employer. Jewish Home supports, and has a strong commitment to the principles of equal employment opportunity. Jewish Home makes employment decisions on the basis of job-related criteria, including merit, qualifications and ability. It is the policy of Jewish Home and its employees to comply with all applicable laws which prohibit discrimination in employment or service, and make all decisions without regard to an employee’s or applicant’s actual or perceived religion, race, pregnancy, ethnicity or ancestry, status as a victim of domestic violence, creed, color, national origin, sex, age, disability, marital status, sexual orientation, gender identify or expression, veteran status, citizenship status genetic information or predisposing genetic characteristics, or because of any other characteristic protected by federal, state, or local law, regulation or ordinance.

Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Two or More Races (Not Hispanic or Latino)
Persons who identify with two or more race/ethnic categories named above.
Hispano o Latino
Una persona de cultura Cubana, Mexicana, Puertorriqueña, América del Sur o Central o de otra cultura hispana u origen independiente de la raza.
Indígena Americano o Nativo de Alaska (No Hispano o Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Asiático ( No Hispano o Latino)
Una persona con su origen en cualquiera de la gente del Oriente Medio, Sudeste Asiático o el Subcontinente Indio incluyendo, por ejemplo, Cambodia, China, India, Japón, Corea, Malasia, Pakistán, las Islas Filipinas, Tailandia, y Vietnam.
Negro o Americano Africano (No Hispano o Latino)
Una persona con su origen en cualquiera de la gente original de la América del Norte y del Sur (incluyendo la América Central) y que mantenga una afiliación tribal o asociación comunitaria.
Nativo del Hawái o de Otras Islas del Pacífico (No Hispano o Latino)
Una persona con su origen en cualquiera de la gente de Hawái, Guam, Samoa, u otra Isla del Pacífico.
Blanco (No Hispano o Latino)
Una persona con su origen en personas de Europa, Oriente Medio o África del Norte.
Dos o más razas (No Hispano o Latino)
Persons who identify with two or more race/ethnic categories named above.

Pre-Employment Request for Veteran Classification

1. The New Jewish Home is a Government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

  • A disabled veteran is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
  • A recently separated veteran means any veteran during the three-year period beginning on the date of such veterans discharge or release from active duty in the U.S. military, ground, naval, or air service.
  • An active duty wartime or campaign badge veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
    • The following periods of war:
      • a. Persian Gulf War – August 2, 1990 to present
      • b. Vietnam Era – February 28, 1961 – May7, 1975 for veterans serving in the Republic of Vietnam or August 5, 1964-May 7, 1975 for all other cases; or 
      • c. Korean Conflict – June 27, 1950 – January 31, 1955
  • An Armed forces service medal veteran means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Protected veterans may have additional rights under USERRA - the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labors Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

2. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

  • Form CC-305
  • OMB Control Number 1250-0005
  • Expires 04/30/2026
Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:


  • Alcohol or other substance use • disorder (not currently using drugs illegally)
  • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
  • Blind or low vision
  • Cancer (past or present)
  • Cardiovascular or heart disease
  • Celiac disease
  • Cerebral palsy
  • Deaf or serious difficulty hearing
  • Depression or anxiety
  • Diabetes
  • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
  • Epilepsy or other seizure disorder
  • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
  • Intellectual or developmental disability
  • Mental health conditions, for example, depression, bipolar disorder, anxiety • disorder, schizophrenia, PTSD
  • Missing limbs or partially missing limbs
  • Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
  • Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS))
  • Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
  • Partial or complete paralysis (any cause)
  • Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
  • Short stature (dwarfism)
  • Traumatic brain injury
Please check one of the boxes below:

 

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Candidate Acknowledgment

I certify that the information that I am submitting in this application is true and correct to the best of my knowledge.  I authorize investigation of all matters contained in this application and agree that any misleading or false statements shall be cause for rejection of this application or would be sufficient cause for dismissal if I am employed by The New Jewish Home.

I understand that my employment is contingent upon satisfactory completion of a post-offer physical examination, including but not limited to drug/alcohol screening by the Employee Health Clinic, the receipt of documents for required immunizations,and the receipt by The New Jewish Home of satisfactory work reference(s). 

I authorize The New Jewish Home to inquire into my educational, professional and past employment history and references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to The New Jewish Home and will hold The New Jewish Home and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information.  

I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time.

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