Applicant’s Statement Regarding Caregiving History
I attest that I, the applicant, have never abused, neglected, sexually assaulted, exploited or deprived any person nor have I subjected any person to serious injury as a result of intentional or grossly negligent misconduct.
Waiver and Release of Information
I understand and agree that any consequential omissions or misrepresentations made by me on this application will be sufficient cause for cancellation of this application and/or termination by Homewatch CareGivers if I have been employed. I understand that any offer of employment will be at the will of Homewatch CareGivers and that the company reserves the right to terminate my employment at any time, with or without prior notice and that I am free to resign at any time with or without prior notice. I understand that no representative of the company has the authority to make any assurances to the contrary.
I, hereby authorize Homewatch CareGivers to request and receive from all prior employers within one year of the date of this application, any and all pertinent information concerning my prior employment and its termination, including the reasons for such termination. I also release Homewatch CareGivers and its representatives from all liability from any damage that may result from furnishing the same to you. This includes a criminal background history, workers’ compensation investigation and/or Social Security check. This may also include random drug testing.
I also understand that any offer of employment may be conditioned upon satisfactory completion of a physical exam or medical evaluation.