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All Care Professional Home Health, Inc.EMPLOYMENT APPLICATION

All Care Professional Home Health, Inc. IS AN EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER AND FULLY COMPLIES WITH APPLICABLE FEDERAL, STATE AND/OR LOCAL LAWS, ORDERS AND REGULATIONS. We do not discriminate in employment on the basis of age, race, color, national origin, religion, gender, physical or mental disability or any other basis prohibited by law. Individuals with disabilities will be provided reasonable accommodation where necessary for the application process or to perform essential job duties. In order for you to be considered for employment, this application must be filled out in its entirety. Resumes are welcomed but should NOT be submitted in lieu of information requested below.

This company desires to promote a drug-free workplace. Employees may be asked to submit to a drug and alcohol test. Covid vaccine is required.

EDUCATION




PERSONAL HISTORY

EMPLOYMENT RECORD

GIVE A COMPLETE RECORD OF YOUR EXPERIENCE STARTING WITH YOUR PRESENT OR MOST RECENT POSITION. (YOU MUST LIST ALL EMPLOYERS FOR AT LEAST THE PAST 10 YEARS.) ATTACH ADDITIONAL SHEETS IF NECESSARY. Resumes are welcomed but should not be submitted in lieu of information requested below.



PROFESSIONAL WORK REFERENCES

(List only persons we may contact at this time.)



ACKNOWLEDGMENT – READ CAREFULLY

The facts set forth above in my application are true and correct. I understand that any false statements on this application or any other company document shall be considered a sufficient basis for dismissal, regardless of when discovered. I also understand that if I am employed, my employment will be at will, meaning that employment may be terminated by me or the company for any or no reason, with or without cause, at any time. I further understand that nothing in this application is to be considered in any way as a contract of employment. I acknowledge and agree that any statement or representation, whether written or oral, past or present, which is contrary to my right and the company’s right to an at-will employment relationship, is void and unenforceable and should not be relied upon in absence of a written contract or employment signed by the President of the company specifically stating otherwise.

I hereby authorize the company to conduct any investigation it deems necessary regarding my application. I also hereby authorize the company to gather and release information about me, together with its opinion on these matters, without any liability for damages whatsoever caused either directly or indirectly by giving or receiving such information or opinions. I authorize any former employer, present employer, schools, colleges and universities, personal references and/or any other person or persons to give the company any information or opinions they may have concerning me, my character or my employment record. I hereby unconditionally release the company, any former employers, their agents and employees and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand that the company may, in the course of its investigation of my application, obtain an investigative consumer report on my, as defined in Public Law 91-508, and I understand that such report may include information as to my character, general reputation, personal characteristics, working skills and abilities, and mode of living. I understand that the company is required to furnish to me upon proper request and within a reasonable time, according to the law, the nature and scope of the investigation.

FOR HUMAN RESOURCES DEPARTMENT ONLY – DO NOT WRITE BELOW THIS LINE.