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EMPLOYEE APPLICATION

  Application for Employment

Yes
No
Yes
No

  Position Desired

Hourly
Daily
Annually
Full-time
Part-time
Weekends
Holidays
Nights
Overtime

Education

Yes
No
Yes
No
Yes
No
Yes
No

Work Experience

Please list all previous employment from at least the last year, beginning with the most recent.  If you need more room, you may attach another sheet of paper.

Yes
No
Yes
No
Yes
No

*I hereby authorize Hand of Hope Homecare LLC to request and receive from all prior employers within one year of the date of this application, any and all pertinent information concerning my prior employment and its termination, including the reasons for such termination.

References

Identify at least two persons who know your work, beginning with the most recent. If you have worked within the one year period preceding the date of this application, you are required to provide this reference.

Background Check

I authorize the company to conduct a criminal background check prior to employment.

Authorization and Acknowledgements

I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. 


I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. 


I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.

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