Careers

EMERGENCY CONTACT INFORMATION

EDUCATION

EMPLOYMENT HISTORY Indicate below all current and past employers. Please account for any gaps or periods of unemployment.

PROFESSIONAL REFERENCES Please list three individuals below, who have knowledge of your work performance during the last five years.

Eligibility and Background Questions NON-DISCRIMINATION Our agency prohibits discrimination against and harassment of any employee or any applicant for employment because of race, color, national or ethnic origin, age, religion, disability, sex, sexual orientation, gender identity and expression, veteran status or any other characteristic protected under applicable federal, state or local laws.

Acknowledgements I hereby certify that the foregoing answers are true and complete to the best of my knowledge. I understand that any misrepresentation, falsification or omission of facts on this application or other forms that I may submit in connection with my application for employment, will be sufficient cause not to hire or cause to terminate my employment whenever discovered. I authorize the authorities of Helping Hands In Home Care (the “Agency”) to investigate references and all other statements made on this application and authorize any entity or individual to provide information related to this application including but not limited to: employment records, including attendance records, work performance, disciplinary reports, letters of reprimand, involuntary termination information and other disciplinary action, without giving me notice of such disclosure. I authorize the Agency to make inquiries of courts and law enforcement agencies for records of prior convictions. I acknowledge that I am not obligated to disclose sealed or expunged records of convictions or arrests, and I understand that the Agency will not consider such information in making any employment decision. I agree to cooperate fully with the Agency's background checking process, including, but not limited to executing any additional consent forms necessary to conduct background checks or drug testing. If a conditional job offer is extended, I hereby give permission to conduct a pre-employment screening, which may include background checks, drug screening and a complete physical examination. I expressly agree not to hold the Agency liable in any manner in connection with the investigations and inquiries described above. I understand that if I become employed I will abide by all Agency rules and policies. I also understand that employment with the Agency is "employment at will" and that my employment and compensation may be terminated, with or without cause, with or without notice, at any time at the option of the Agency or myself. This application is not a contract or guarantee of employment.

Background Check By checking the authorization below, I hereby authorize Helping Hands In Home Care, Inc. to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that Helping Hands In Home Care, Inc. will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further. *Please note if you are hired there will be a $45.00 fee deducted from your first paycheck for the background check procedures.

Testing Authorization If offered a position with the Agency, I hereby agree to any legally permitted physical, psychological, competency, skill, drug, or medical test required by the Agency as a condition of employment.

Investigation Authorization I authorize initial and post-hire investigations into all statements and references contained in this application. Said investigation may include: OIG Exclusion List Verification, Aide Certification Verification, Vehicle Insurance Verification, Fingerprint Clearance Card Verification, Credit, Driving, Criminal background, reference checks, and other background checks.

Work Hazards I understand that if I accept employment with the Agency, I may be exposed to potential hazards related to the provision of homecare services within private residences or medical facilities. Such hazards include but are not limited to physical exertion related to heavy lifting, continuous motion, standing for long periods of time, and exposure to on the job chemicals such as cleaning agents and medications.

Agreement By typing my initials and my complete name below, I acknowledge that I have read and understood the policies and conditions contained herein and agree to be bound by them if employed by Helping Hands In Home Care.