Care Home Health Agency Application For Employment (Page 3 of 4) in pdf

CARE HOME HEALTH AGENCY

Applicant Authorization

PLEASE READ BEFORE SIGNING

If you have any questions regarding the following statements, please ask prior to signing.

Care Home Health Agency does not discriminate in hiring or employment on the basis of race, color, religion, age, disability,

veteran status, or status within any group protected by federal, state, or local law. No questions on this application are intended to

secure information to be used for any such discriminatory purpose.

This application will be given every consideration, but our receipt of it does not imply that you will be offered employment.

By signing your name below, you authorize investigation of all statements contained herein and the reference and employers

listed to give you any and all information concerning your previous employment and any pertinent information they may have,

personal or otherwise, and release Care Home Health Agency from any liability for any damage that may result from the utilization of

such information.

By signing your name below, you certify that all statements made by you on this application are true and complete to the best

of your knowledge and that you understand that misrepresentations or omissions may be cause for rejection, or may be cause for

subsequent dismissal if you are hired or prosecution.

By signing your name below, you understand that nothing contained in the application or in the interview process is intended

to create an employment contract between you (the applicant) and Care Home Health Agency. Should this application result in your

employment, you have a right to terminate your employment at any time and for any reason and Care Home Health Agency retain a

similar right. You further understand that no representative of Care Home Health Agency other than {Nursing

Supervisor/Administrative Staff} has any authority to enter into any agreement with you for any specified period of time or to

guarantee some other personal move or benefit. You further understand this entire statement applies to the period prior to and after

you may be employed.

I hereby acknowledge that I have read, understand, and agree to the above statements.

_____________________________________

_____________________

Signature of Applicant

Date

Care Home Health Agency Application For Employment Page 3