Employment Application

Personal Information

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Previous Employment (Company 1)

Previous Employment (Company 2)

Previous Employment (Company 3 )

Certification

Do you have the legal right to live and work in the USA (we hire only US Citizens and aliens lawfully authorized to work here. Proof that you have legal employment status will be required if you are hired.
Have you ever worked for us before?
Have you received any job related training from the United States Military
Have you ever been convicted of a crime other than a minor traffic violation. (conviction will not necessarily disqualify an applicant from consideration for employment.)

Education

Highschool

Did you graduate?

Technical or Business school

Did you graduate?

College

Did you graduate?

Other

Did you graduate?

Professional and Community Involvement

References

Name three persons who have firsthand knowledge of your work skills and experiences (other than current or previous supervisors/ employers or relatives).

Reference 1

Reference 2

Reference 3

Guardian Angels V Elim Home Care, Inc. will consider all applicants for employment without regard to race, color, religion, sex, national origin, age, marital status, disability, sexual orientation or any other legally protected category as may be provided by Federal, State, or local statute or ordinance.  We Are an Equal Opportunity Employer

I am a serious applicant for employment with Guardian Angels Elim Home Care. I certify that the information I have provided both orally and in writing is accurate and complete. I authorize Guardian Angels Elim Home Care and any agent acting on its behalf to confirm this information and to secure other necessary or relevant information from my employers, references, credit bureaus, academic institutions, governmental agencies, and other sources. If I become employed by Guardian Angels Elim Home Care, this authorization shall remain in effect throughout my employment. 


I specifically authorize all employers and former employers to provide information that includes but is not limited to the following: verification of my application details; information requested on the attached sheet(s); information on duties of employment; compensation and wage history; job description and duties; training and education provided by employers or former employers; acts of violence, theft, harassment, or illegal conduct documented in my personnel record that resulted in disciplinary action or resignation, and my written response, if any, contained in my personnel record; written employee evaluations conducted before my separation from employment, and my written response, if any, contained in my personnel record; and written reasons for separation from employment. 


I release all such sources and providers of information from all claims or damages arising from or related to the furnishing of information about me that appears reasonably to be true. I release Guardian Angels Elim Home Care, Elim Care, and all affiliated persons, agents, and employees, from all claims or damages arising from or related to the receipt or use of any and all iriformation about me. 
I understand that I have rights under the Fair Credit Reporting Act, notice of which has been provided to me. 

I understand that, if my application for employment is successful, I may be given a conditional offer of employment that is dependent on .the results of a drug and alcohol test; criminal background check; a "consumer report" as defined in the Fair Credit Reporting Act; a Mantoux or other tuberculin sensitivity test; or tests to determine physical capacity or other ability to perform the job safely and competently. If employed, my employment will be "at will." Guardian Angels Elim Home Care and I have agreed on any period of employment, wage, or benefits. 

I have read the above statement and and agree with it's conditions.
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List professional, trade, business or civic organizations and activities in which you are or have been actively involved.  Please exclude any memberships or activities which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status:

© 2018 Guardian Angels Elim Home Care and Hospice

Christian Mission † Community Based † Continuity of Care