Applications

Job Application
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Enter your full address including house number, city, and zip code
Enter your permanent address including house number, city, state and zip code
Are you a citizen of the United States? *
If no, do you have a valid work permit? *
If you are under 18, can you furnish a work permit? *
Employement Desired *
CNA, CARE AIDE , SITTER , LPN or RN
Enter date you are most confortable to start working
Enter expected hourly pay
Are You Employed Now? *
If so, can we contact your present employer? *
Have you ever applied to this company before? *
Are you on layoff and subject to recall? *
Will you travel if required? *
Will you relocate if job requires it? *
Will you work overtime if required? *
Are you ready to meet the attendance requirement of this position *
Have you ever been Bonded *
Have you ever been convicted of Felony in the past 7 years? *
Enter state where your driver's license if approved
Are you currently studying? *
Enter name of your high school
Did you graduate? *
Did you graduate? *
List other certificates you have received with time period of study
Enter job experience with responsibilities, contact details of the company and salary received per hour
Enter at least 2 references, listing full name, address, phone, email, work information and position
Enter your full emergency contact details
Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on company premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes willingness on the part of the applicant or employee to agree to physical examination, polygraph and/or substance testing, if required by the company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy will result in dismissal. *
It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign anytime, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary. *
I give the employer the right to investigate all police, driving, and personal records and references, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organization for furnishing such information. *
The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, State or Federal law. *
Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory,tort or contract claims, will be submitted to mediation and failing settlement in mediation, to binding arbitration. Unless otherwise agreed a mediation and arbitration designated by staff professionals will govern any mediation and arbitration. The parties will select the mediator or arbitrator from the designated company panel of mediators and will notify the designated company, in writing, to initiate the selection process. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act. 9 U.S.C. Section 1-et seq. The parties hereto stipulate that this agreement involves matters affecting interstate commerce. *
This application is current for 60 days. At the conclusion of this time if I have not heard from the Employer and still with to be considered for employment, it will be necessary to fill out a new application. *

Maximum file size: 268.44MB

Supported Document Type: Pdf, Doc, Docx
Confirm your application is complete and correct *
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