Employment Application
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- Complete ALL parts of this application

- Application will be valid for 60 days.

Applicant Note: This application form is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Staffing franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form, are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body may be required prior to employment.
Please select
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Emergency Contact

Availability

Due to the nature of the business, no guarantee can be made as to the schedule or the number or the number of hours worked.
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Preferences

Job Related Skills

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Employment Application
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*For employment, our minimum education requirement is either a GED or High School diploma

Work History

Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.
Most Recent Employer
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Second Most Recent Employer
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Third Most Recent Employer
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If yes, please describe:

Professional References

(Do not include relatives)
Please complete all four references. Your application will not be considered unless four references are provided. Since we will contact these references, please notify them in advance. If we are unable to reach all four references, you will be asked to provide additional references.
CERTIFICATION AND RELEASE:
I certify that I have read and understand the applicant note on page one (1) of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that this application is not a contract of employment. My employment is contingent upon confirmation of credentials and successful completion of drug test or criminal background check. I also understand that if hired, regardless of any oral presentations to the contrary, the employment relationship between True Vision Staffing, Inc. and myself is terminable at-will, so that both the company and I remain free to choose to end out work relationship at any time for any reason or no reason. Any changes in this employment relationship must be made in writing. My signature below acknowledges that I have read, understand, and agree to the above disclosure. I also understand that due to the nature of the business, no amount of work can be guaranteed.
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Employee Timesheet Policy
The purpose of this policy is to ensure timekeeping and payroll methods are accurate and reliable. The timesheet is the basis for contract invoicing and payroll; therefore it is very important that accurate, daily records be maintained. Timesheets are used to keep track of how employee's work time has been allocated during the timesheet period and are a legal record. Maintaining an accurate and complete Timesheet is part of your job. The timesheet is what the employee must use to record all of their hours for that pay period.
Pay Period. A pay period is two weeks (14 days) beginning on a Friday and ending on a Thursday. Employees are paid bi-weekly.

All Employees have access to a timesheet on the company's website:

True Vision Staffing Care

Policy and Procedures for Recording Hours Work

1. All employees are required to record all hours worked within the correct Pay Period.

2. All employees must accurately document Lunch Break times in and out.

3. All employees must update the timesheet after every shift. Timesheets should be updated at the end of each work day.

4. All shifts on the timesheets requires a signature by the Charge Nurse of that shift or Supervisor. This is important for payroll and invoice processing.

5. At the end of the pay period, make sure that your hours have been entered correctly, that you are not missing any shifts.

6. It is the employee's responsibility and the expectation of True Vision Staffing, Inc. that all employee's accurately and honestly record all time worked.
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Acknowledgement of Preventing Employment Discrimination Against Lesbian, Gay, Bisexual or Transgender Workers

Employment discrimination is illegal. Discrimination occurs when you are being treated differently than others (or are harassed) because of your race, color, national origin, sex, pregnancy, religion, age, disability, or genetic information. It is also against the law for an employer to retaliate against you because you report discrimination against you or on behalf of others. 

Although Title VII of the Civil Rights Act of 1964 does not explicitly include sexual orientation or gender identity, the EEOC and courts have said that sex discrimination includes discrimination based on an applicant or employee's gender identity or sexual orientation. For example, it is illegal for an employer to deny employment opportunities or permit harassment because:

- A woman does not dress or talk in a feminine manner.

- A man dresses in an effeminate manner or enjoys a pastime (like crocheting) that is associated with women.

- A female employee dates women instead of men.

- A male employee plans to marry a man.

- An employee is planning or has made a gender transition from female to male or male to female.

Who is Protected?

Title VII applies to all private sector and state/local government employers with at least 15 employees. Note: State or local laws in your jurisdiction also may explicitly prohibit employment discrimination based on sexual orientation or gender identity.

Applicants and civilian employees of federal government agencies also have rights against LGBT discrimination under Title VII, and also Executive Order 114478, as amended.

Discrimination against an individual because that person is transgender, by definition discrimination based on sex, and violates Title VII. Macy v. Department of Justice, EEOC Appeal No. 0120120821 (April 20, 2012) (transgender discrimination is sex discrimination in violation of Title VII because it involves non-conformance with gender norms and stereotypes, or based on a plain interpretation of the statutory language prohibiting discrimination because of sex); Lusardi v. Dep't of the Army, EEOC Appeal No. 0120133395 (March 27, 2015) (Title VII is violated where an employer denies an employee equal access to a common restroom corresponding to the employee's gender identity, or harasses an employee because of a gender transition, such as by intentionally and persistently failing to use the name and gender pronoun corresponding to the employee's gender identity as communicated to management and employees). 

Discrimination based on sexual orientation also necessarily states a claim of sex discrimination under Title VII because (1) it literally involves treating an applicant or employee differently based on his or her sex, (2) it takes sex into account by treating him or her differently for associating with a person of the same sex, and (3), it involves discrimination based on gender stereotypes -- employer beliefs about the person to whom the employee should be attracted because of the employee's sex. Baldwin v. Dep't of Transportation, EEOC Appeal No. 01200133080 (July 15, 2015). Examples of sex discrimination involving sexual orientation include: 

- Deny an employee a promotion because he or she is gay or straight.

- Discriminating in terms, conditions, or privileges of employment, such as by providing a lower salary to an employee because of sexual orientation, or denying spousal health insurance benefits to a female employee because her legal spouse is a woman, while providing spousal health insurance to a male employee whose legal spouse is a woman.

- Harassing an employee because of  his or her sexual orientation, for example, by derogatory terms, sexually oriented comments, or disparaging remarks for associating with a person of the same or opposite sex.

It also violates Title VII to discriminate against or harass an employee because of his or her sexual orientation or gender identity in combination with another unlawful reason, for example, on the basis of transgender status and race, or sexual orientation and disability.

How Do I Report Workplace Discrimination?

Employees or applicants of a private company, state government, or local municipality: EEOC will investigate complaints of employment discrimination, harassment and retaliation and may act to stop it and seek remedies on your behalf for free. We accept complaints from job applicants, employees (full-time, part-time, seasonal and temporary), and former employees. Regardless of your citizenship and work authorization status, the law still protects your. Complaints may be filed by mail or in person at the nearest EEOC office. Visit www.eeoc.gov to find out more about laws against employment discrimination. In some cases, you have 180 days to file a complaint. In others, you have 300 days. Call us immediately if you believe you experienced discriminaton.

Federal government applicants and employees should contact their agency EEO office within 45 days of experiencing discrimination to pursue a Title VII claim. Federal employees also may have rights to pursue claims in internal processes governed by E.O. 11478.

The Equal Opportunity Commission is the federal agency that enforces laws against employment discrimination, harassment, and retaliation. We have offices around the country that can help you. We can explain whether the situation you face is lawful or unlawful.
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HIPAA ACKNOWLEDGMENT

As an employee of consultant or volunteer of True Vision Staffing Care Inc. or as a student receiving training at the Facility (Including, not limited to, students from or medical, pharmacy, physician's assistant, health information and nursing schools, I have informed of the facilities ethical, moral and legal responsibility to safeguard the privacy of all residents, and to protect and secure their health information. I affirm my commitment made at the time of employment/assignment to protect confidentiality/security of health information.

I understand that I am not to release any information to unauthorized person(s), and to follow the facility policies and procedures on disclosure information. I understand that I must use discretion when discussing resident information in the course of my work and that I must be careful to assure that my conversation cannot be overheard by persons or personnel who are not involved in the resident's care.

I understand that information on electronic media, i.e., computerized, video, fax, etc., shall remain as confidential as the paper documents. I understand that if I am assigned access to a computerized file that I will have my own access code and that these codes are not to be shared with any other individual. I will maintain security procedures as requested by the facility. I further acknowledge that anywhere in the electronic record where my name is noted, this is my electronic signature and that this electronic signature can only be assigned by me through use of my personal access code. 

As a condition of working or training with the facility and as a condition of my right to access such Confidential information, I agree to comply with this agreement and all of the facility's policies and procedures. Including those specifically dealing with the confidentiality of patient information. I hereby agree, unless directed by my supervisor or within the allowed policies and procedures related to my job duties, to not data. I understand that this includes any accessing of computerized records from any location other than the facility wen I am not on shift, unless specified as allowable based on my job description.

I understand and agree that I may be subject to sanctions by the Facility if I violate any of the Facility's policies and procedures or the privacy laws. I understand that these sanction may include termination. In addition, I understand that a violation of the privacy laws may subject me to individual criminal and/or civil liability.

I know that True Vision Staffing, Inc. and I understand that I can approach the Human Resources with any questions about this agreement, the facility's privacy practices, privacy law and whether a particular use, access or disclosure of Confidential Information is consistent with the facility's policies and procedures and appropriate under the circumstances.
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Acknowledgment of No Call No Show Policy

As you are aware, the success of our business depends on every employee showing up on time and performing his or her job duties. Employees are expected to arrive on time and ready for work. An employee who arrives after their scheduled time is considered tardy, and times of shift will adjust accordingly. If you are going to be late for your scheduled shift, you must call the Staffing Coordinator as soon as possible. True Vision Staffing, Inc. recognizes situations may arise that could hinder punctuality; regardless, excessive tardiness is prohibited, and may be subject to disciplinary action.

If you are unable to work your scheduled shift, you must call the Staffing Coordinator at least two hours before your scheduled work shift. If you fail to show up for a scheduled shift and do not call, this will be considered a 'No Call No Show' and will result in not being called for another shift until further notice. If you call after your shift has ended, discipline may occur depending on the reason for the missed shift. You are responsible for knowing your scheduled shift, and any changes that may have occurred, therefore not knowing you were scheduled is an unacceptable excuse.
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Dress and Personal Appearance

We are proud of our public image, and we strive every day to maintain our high standards to our clients. We feel that the appearance of our employees is one of the factors that make a positive contribution to the image of True Vision Staffing, Inc.

Our clients form their opinion of our organization through their direct contact with you. You are the image of True Vision Staffing, Inc. We ask that you present yourself to work well-groomed and dressed neatly and appropriately for your job function. And while we trust each employee's common sense and good judgement, team members must dress in a manner that is appropriate for the work environment. Appropriate dress and hygiene are important in promoting a positive Company image to our clients, both internally and externally.

General Guidelines for Everyone

Good personal hygiene is the responsibility of every True Vision Staffing, Inc. employee and is of the utmost importance. Therefore, the following grooming guidelines is a non-exclusive list of our grooming expectations and clothing are not acceptable:

Personal Hygiene and Grooming

- You should bathe daily, as body odor is offensive to clients and other workers

- Your hair should be washed and well groomed

- Beards and mustaches must be clean and neatly groomed.

- Your teeth should be brushed and your breath fresh

- Only light perfumes or colognes are allowed due to sensitivity and potential allergic reactions to scents

- Hands and fingernails should be clean and neatly maintained

- Uniform attire of any kind (i.e. scrubs) are to be washed daily before each work shift.

- Shoes must be of appropriate footwear for safety and working condition.

-Shoes must be clean and in good condition at all times.
As professionals, it is your responsibility to adhere to the Dress and Appearance guidelines. However, if there is a misunderstanding or disagreement about what is appropriate, your supervisor will ask you to modify your appearance, DO NOT be offended, he/she is merely trying to ensure we uphold our image. Management reserves the right to send any person home who is not adhering to the guidelines mentioned. Management will reasonably accommodate any employee's sincere religious practice or disability if it conflicts with the guidelines in this policy.
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Meal  Period and Rest Break Acknowledgement

Meal Periods

I understand that I am entitled to an uninterrupted, thirty-minute meal period for shifts in which I am scheduled to work more than five (5) hours. I also understand that I must be at least two (2) hours into my shift before my meal period can start and that my meal period cannot start more than five (5) hours after the beginning of my shift. In addition, I understand that a second, unpaid thirty-minute meal period must be provided within five (5) hours from the end of the first meal period and for each five (5) hours worked thereafter.

I also understand that I am not paid for these meal periods. I also understand that if my meal period is interrupted due to my performing a task, upon completion of the task, my meal period will be continued until I have received thirty (30) minutes total of mealtime. I understand that I must accurately attest at the end of each shift whether I received my meal break or not. 

Rest Breaks

I understand that I am entitled to and must take a paid rest break of ten (10) minutes for every four (4) hours of work.

I understand rest breaks are paid, and therefore do not need to be noted on my time records. I understand I may not waive these rest breaks, I also understand that it is a mandatory job duty to advise my Manager if I feel I do not have adequate opportunity for my rest breaks or if I am pressured to skip them. I also understand that I must accurately attest at the end of each shift whether I received my rest breaks or not.
I have read and understand this acknowledgment.
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Please use the fields below to upload important and up to date Employment Documents:

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PLEASE NOTE:

You're not done yet!

THE DOCUMENTS IN THE LINKS BELOW ARE REQUIRED AND MUST BE FILLED OUT, SIGNED, and SUBMITTED to the Company's website. WE NO LONGER ACCEPT EMAILED DOCUMENTS.

You can print it out, fill it out, and submit it to the Company's website or electronically sign it through apps (ex: Docusign or Signnow) and submit it to the Company's website.

https://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC508.PDF

LIC 508 Form
https://www.uscis.gov/sites/default/files/document/forms/i-9-paper-version.pdf

USCIS Form I-9
https://www.irs.gov/pub/irs-pdf/fw4.pdf

W-4
https://www.irs.gov/pub/irs-pdf/fw9.pdf

W-9

Once filled out and signed, please upload these forms to the specified fields on our company website on 'Our Staff' tab.

True Vision Staffing, Inc.

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Please see documents below to download:

These documents are also available on our website.

True Vision Staffing Care Website

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