Employment Application

Personal Information:


Employment Desired:


Education:


Employment History: (Begin with your most recent employer first)

Employer 1
From
To
Ext

Employer 2
From
To
Ext

Employer 3
From
To
Ext

References: (Must be professional)


Please Read Carefully Before Agreeing

I authorize the investigation of all statements made by me in this application. This may also include a criminal background check. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may be terminated at any time without any previous notice.

*

The civil rights act of 1964 prohibits discrimination in employment practice because of race, color, religion, sex or personal origin. The age discrimination in employment act of 1967 prohibits discrimination based on age with respect to individuals who are at least 40 but less than 65 years of age.

Accu care home health services, INC. is an equal opportunity employer and complies with federal, state, local and NYSDOH regulations pertaining to employment practices.

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