S

Tiera Simms

240-***-****

ad0sv2@r.postjobfree.com

m

Washington, DC 20001

SUMMARY

Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Offering [Number] years of progressive experience in owning web-based projects from concept and design through testing, implementation and client updates. Diligent about producing exceptionally clean, strong and secure code. Successful at achieving browser, device and operating system compatibility objectives while satisfying client desires and producing robust, sophisticated designs.

Attentive driver with strong knowledge of local routes and traffic patterns. Monitors road conditions and construction areas to maintain schedule adherence. Hardworking and reliable [Job Title] with strong ability in [Task]. Offering [Skill] and [Skill]. Highly organized, proactive and punctual with team-oriented mentality. SKILLS

Active Listening

Planning & Organizing

Team Building

People Skills

Conflict Resolution

Friendly, Positive Attitude

Critical Thinking

Microsoft Office

Customer Service

First Aid/CPR

EXPERIENCE

State of California

My Ethnic Origin is: (See Page 8 for a list of Ethnicities and Codes) B1

What language do you prefer to read?

B2

What language do you prefer to speak? (Please choose one from the list of Languages and Codes on Page 8)

Please choose one Please choose one

Please choose one

State of California – Health and Human Services Agency California Department of Social Services

SOC 295 (9/18) Page 4 of 8

Section 8 – Communication Accommodations

I am Blind: Yes No

To accommodate blind or visually-impaired applicants, IHSS information is available in the following alternative formats

Please indicate which format you would prefer, if applicable Providing information in this section will not affect your eligibility for services If yes, please choose one of the following for each of the three types of Department of Social Services (DSS) documents listed

For Notices of Action: No accommodation is needed Braille Documents Audio CD Data CD County Support (If County Support, describe requested support) For IHSS Required forms: No accommodation is needed Braille Documents Audio CD Data CD County Support (If County Support, describe requested support) For Timesheets: No accommodation is needed

Telephonic System (4 Digit RAN: ) County Support

Electronic Timesheet System (ETS) (Applicants and providers must first register at https://www.etimesheets.ihss.ca.gov) (If County Support, describe requested support) I am Visually Impaired: Yes No

If yes, please choose one of the following for each of the three types of Department of Social Services (DSS) documents listed

State of California – Health and Human Services Agency California Department of Social Services

SOC 295 (9/18) Page 5 of 8

For Notices of Action: No accommodation is needed 18 point font documents Audio CD Data CD County Support (If County Support, describe requested support) For IHSS Required forms: No accommodation is needed 18 point font documents Audio CD Data CD County Support (If County Support, describe requested support) For Timesheets: No accommodation is needed

Telephonic System (4 Digit RAN: ) 18 point font documents County Support Electronic Timesheet System (ETS) (Applicants and providers must first register at https://www.etimesheets.ihss.ca.gov) (If County Support, describe requested support, including blind-only services)

Section 9 – Affirmation

I affirm that the above information is true to the best of my knowledge and belief I agree to cooperate fully if verification of the above statements is required in the future I also understand that as the employer of my IHSS provider(s) I am responsible for: 1 Hiring, training, supervising, scheduling and, when necessary, firing my provider(s) 2

Ensuring the total hours reported by all providers who work for me do not exceed my IHSS authorized hours each month

3

Referring any individual I want to hire to the County IHSS office to complete the provider eligibility process

4

Notifying the County IHSS office within 10 days when I hire or fire a provider Health and Human Services Agency California Department of Social Services SOC 295 (9/18) Page 6 of 8

In addition, I understand and agree to the following terms and limitations regarding payment for services by the IHSS program: 1

In order for any individual to be paid by the IHSS program, they must be approved as an IHSS eligible provider

2

If I choose to have an individual work for me who has not yet been approved as an eligible IHSS provider, I will be responsible for paying him/her if he/she is not approved 3

The IHSS program will not pay for any services provided to me until my application for services is approved and then will only pay for those services that are authorized for me to receive by the IHSS Program

4

I will be responsible for paying for any services I receive that are not included in my IHSS authorization

5

I will be responsible for paying my Share-of-Cost (SOC) and informing my individual provider(s) of that SOC

I also understand and agree to cooperate with the following as a part of my eligibility for

IHSS:

To promote program integrity and quality assurance, I may be subject to

(un)announced visits to my home and that I or my provider(s) may receive letters identifying program requirement concerns from the State Department of Health Care Services (DHCS), California Department of Social Services (CDSS) and/or the County in which I receive services

The purpose of the visits and letters is to ensure that program requirements are being followed and that the authorized services are necessary for you to remain safely in your home

The visit will also verify that the authorized services are being provided, that the quality of those services is acceptable, and that your well-being is protected If it is found that IHSS services are not required or not being properly provided, you and/or your provider may be subject to a Medi-Cal fraud investigation If fraud is substantiated, you and/or your provider will be prosecuted for Medi-Cal fraud State of California – Health and Human Services Agency California Department of Social Services

SOC 295 (9/18) Page 7 of 8

Section 10 – Signature(s)

Signature of Applicant, Date:

Signature of Applicant's Representative (only if applicable): Date: Representative's Relationship to Applicant (only if applicable): Representative's Telephone

Number (only if applicable):

Representative's Address (only if applicable):

To report suspected fraud or abuse in the provision or receipt of IHSS services, please call the fraud hotline at 1-800-***-****, email at ad0sv2@r.postjobfree.com, or go to http://www.dhcs.ca.gov/individuals/Pages/StopMedi-CalFraud.aspx. EDUCATION AND TRAINING

Certificate

Hair Academy Inc - New CarrolltonMar 2013

Hyattsville, MD

ACCOMPLISHMENTS

Income Eligible:

Yes No

Status Eligible:

Yes No

Medi-Cal Aid Code:

MAGI Eligible Recipient:

Disabled 12 months or longer

At risk without IHSS

Verification:

Notes:

Signature of Social Worker or Agency

CERTIFICATIONS

1. American Sign Language (AMISLAN or ASL). 2. Spanish - NOA will be issued in Spanish. 3. Cantonese. 4. Japanese. 5. Korean. 6. Tagalog. 7. Other non-English. 8. English. 9. Spanish - NOA will be issued in English. 10. Other Sign Language. 11. Mandarin. 12. Other Chinese Languages. INTERESTS

Open to learn different things far as computers programming.Education development.Office settings working different task with team members.Customer Services. working with heavy equipment. Cosmetology designing.Health and wellness.

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