I do not have a felony conviction in this state or any other state, and I attest to not have been convicted of any sexual assault charges, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a resident or have not had a finding by the department or any administrative agency in this or any other state for fraud, abuse, neglect or exploitation of any person.
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Symptom History
Have you experenced any of the following symptons in the last 14 days?
Contact History
Travel History
No Place Like Home LLC will review your form and contact you if needed. Our goal is to keep you, NPLH staff, and clients safe. Please make sure to wear a mask when entering all NPLH's buildings and client's homes.
NPLH expects all potential and current employee’s to self-screen every day and report any of the above symptom directly to NPLH management before entering NPLH's buildings and client’s home.