Employment Application Form

All About Caring For You

Employment Application

    Employer Information

    It is the policy of All About Caring For You to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

    Applicant Full Name

    Emergency Contact

    Who should be contacted if you are involved in an emergency?

    Have you applied to our company previously?

    Are you at least 18 years old?

    How will you get to work?

    Are you willing to work any shift, including nights and weekends?

    If hired, are you able to submit proof that you are legally eligible for employment in the United States?

    Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?

    Applicant’s Skills

    Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

    Applicant Employment History

    List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

    Applicant’s Education and Training

    Did you receive a degree?

    Did you receive a degree?

    Other Training (graduate, technical, vocational)

    Please indicate any current professional licenses or certifications that you hold

    Awards, Honors, Special Achievements

    Military Service

    Branch

    Specialized Training

    References

    List any two non-relatives who would be willing to provide a reference for you.

    Name

    Address

    City/State/ZIP

    Telephone

    Relationship

    Name

    Address

    City/State/ZIP

    Telephone

    Relationship

    Please provide any other information that you believe should be considered, including
    whether you are bound by any agreement with any current employer:

    CERTIFICATION

    I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

    I authorize All About Caring For You to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

    If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Director, the employmentrelationship will be “at-will.” In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of All About Caring For You, except in a specific written contract of employment signed on behalf of the organization by its Director, has the power to alter or vary the voluntary nature of the employment relationship.

    I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

    APPLICANT SIGNATURE

    DATE

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