• Dignity Care Home Employment Application

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  • Education

  • Former Employers

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  • References

    Give the names of three people not related to you whom you have known for at least a year.
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  • Emergency contact and signatures

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  • I certify I have not been convicted/adjudicated of an offense which prohibits employment in an adult care home pursuant to K.S.A. 39-970 or K.S.A. 65-5117 (Copy of prohibited offenses available upon request.)

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  • "I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

    In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the complay's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other that it's president, and then only when in wrong and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."

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  • Should be Empty:
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