* = Required Information

Employer Application

We do not discriminate based on race, color, religion, national original, sex, age, ordisability.It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

Personal Information
Yes No
General Question
Yes No
Yes No
Yes No
Yes No

A “yes” answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will be considered

Yes No
Position Information
Full Time Part Time Contract
Mon Tue Wed Thu Fri
Education
Special Skills
References
Yes No
Yes No
Business References (Give 3 References, not relatives)

Work History

List names of employers with present or last employer listed first. Account for all periods of time, including military service and any period of unemployment. IF self-employed, give firm name and supply business references. Provide telephone numbers and names of individuals to contact.

Were you

Were you

Were you

AFFIDAVIT

We do not discriminate based on race, color, religion, national original, sex, age, ordisability.It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

I CERTIFY that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered later.

I UNDERSTAND that RX Team Home Health Care LLC may request an investigation consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living ontained from interviews with neighbors, friends, former employers, schools and others. I understand I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.

I AUTHORIZE the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except as previously noted), past employers and organizations from any legal liability in making such statements.

I UNDERSTAND THAT THIS APPLICATION DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL FOR THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.