Emergency Contact Information
EDUCATION & TRAINING
List all of your work experience beginning with your most recent job. You will be asked to explain all gaps in employment.
ACKNOWLEDGMENT (Please read carefully and sign)
In signing this application, I certify that I have read and fully understand the questions asked in this application and that all answers given by me are true, accurate, and complete. I also understand that the omission, concealment, or misrepresentation of any fact on this application or during any interview for employment may jeopardize my chances for employment and be cause for my immediate dismissal from employment.
I give Adya Hospice & Palliative Care LLC permission to use any information in this application to enable it and its agents to verify the information contained in this application. I also authorize present and former employers, educational institutions I have attended, credit agencies, all references, and any other persons to answer all questions asked by Adya Hospice & Palliative Care LLC with regard to any of the subjects covered by this application. I also understand that in connection with my application for employment or my employment, Adya Hospice & Palliative Care LLC may conduct a criminal background investigation and that my employment may be contingent on the results of such investigation. I release Adya Hospice & Palliative Care LLC, its agents, and all affiliated entities, as well as any person or situation that provides any information about me, from any and all liability whatsoever resulting from any such investigation or the disclosure of such information.
I am willing to submit to a physical examination, including the analysis for the detection of the use of unlawful drugs or substances in accordance with applicable laws. I agree that my continued employment may be contingent on the results.
In compliance with the Immigration Reform and Control act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment.
In consideration of my employment and of my being considered for employment by Adya Hospice & Palliative Care LLC, I agree to abide by all rules and regulations, which I understand are subject to change at any time for any reason without prior notice. I also understand that if employed, I will be an employee at-will and employed for no definite period of time. I understand that either Adya Hospice & Palliative Care LLC or I can terminate my employment at any time, with or without cause and with or without advance notice. I further understand that no communication, whether oral or written, by any representative of Adya Hospice & Palliative Care LLC, at any time, can constitute a contract of employment. No representative or agent of Adya Hospice & Palliative Care LLC has the authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.