Personal Information

Please provide your last seven (7) addresses:

Availability for Work

Background

Check skills in which you are experienced (where appropriate):

Education

Work Experience

Please list previous 3 employers. 
 
Most Recent Position:

Second Most Recent Position:

Third Most Recent Position:

Certifications

Certificates or Licenses Held:

List 3 references here. Please include one person you have known for at least 5 years. Please do not list relatives

U.S. Equal Opportunity Employment Information 

 Volunteer Home Care is an Equal Opportunity Employer. We consider applicants without regard to religion, color, race, age, sex, national origin, physical or mental disability, marital status, ancestry, veteran status, gender identity, or sexual orientation. We are giving you the opportunity below to assist us with federal and state Equal Opportunity/Affirmative Action record keeping and reporting compliance. Participation is strictly voluntary and will not impact our hiring decisions.  Answers to these questions are kept in the strictest confidence. We appreciate your help and cooperation.

Abuse Registry Screening

been found guilty of abuse, neglect or misappropriation.  I give my permission for Volunteer Home Care (the “Company”) to access all prior records pertaining to any past allegations of abuse, neglect and/or misappropriation, including personnel and investigative records and to consider this information for the purposes of hiring or denying employment with the Company.

Authorizations 

 The information furnished in this application is true and accurate to the best of my knowledge. Any false information given on this application may result in my not being considered for employment, or in my immediate dismissal should I be hired. This application is considered valid and will be kept on file for sixty days. At the end of this sixty-day period, I will be required to re-submit for further consideration. All information submitted on this application, including prior employment history and reference information is strictly confidential and will not be shared with anyone other than authorized Company personnel.

I understand that there are certain pre-screening requirements that take place in order to be considered for employment at Volunteer Home Care. A Background Evaluation is a condition for employment. This evaluation includes, but is not limited to:  prior employment verification, reference verification, criminal background check (county of residence, current and prior, state and national), abuse registry, and other checks not prohibited by law. I give my permission for the Company to perform this evaluation and hold the Company harmless for any information that should arise.  I also understand that a pre-employment drug screen is required and consent to such testing during the pre-employment period and during the course of employment upon request by the Company.

My employment with the Company is not for any specified period of time and is indeed, at will. This means that I may be terminated at any time, with or without cause. Should I give false or misleading information on this employment application, I understand that immediate dismissal may result.

I agree that any and all claims arising out of or that may be related to my employment with the Company, such as claims arising in tort or contract, claims for discrimination under federal, state or local law, claims for defamation, claims for or related to wages, including claims for unpaid wages, overtime and unlawful deductions for wages, will be resolved through non-class, final, mandatory, and binding arbitration, conducted by a mutually agreed upon and neutral arbitrator; with the exception of worker’s compensation, unemployment compensation, unfair competition/trade secret claims, breach of confidentiality, and any restrictive covenant claims. After I pay a filing fee equal to the fees applicable in local courts, the Company will bear the costs of the mutually selected arbitrator, a stenographer for the arbitration hearing, and the American Arbitration Association fees. Any arbitration will be governed by the National Rules for the Resolution of Employment Disputes of the American Arbitration Association, except as otherwise mutually agreed to by the parties. I can request and receive copies of these rules from the Company.

By electronically signing this application for employment, I certify that