To Whom It May Concern: I give, * my former employer, authorization to provide a reference check to my potential employer, Age in Place Home Care. I am aware and acknowledge the information referred to above is not shared with any third parties. By signing below I give the employer consent to collect the information contained herein and use for the purpose specified. Signed: Signature* Print Name: First Name* Last Name* Address: Street Address* Address Line 2* City* State* Zip*
Check all areas of client "Home Services" that you have experience working with. Provide notes if required.
To Whom It May Concern: I give, * my insurance Broker, authorization to release to my employer the following information: • Automobile insurance policy information;• Copies of automobile policies and certificates of insurance.I also give authorization to advise my employer of any changes in my automobile insurance. I am aware and acknowledge the information referred to above is not shared with any third parties except the employer if requested at any time for audit. The information is used by the employer to confirm adequate and proper insurance coverage of my automobile while being used in the course of my employment. By signing below I give the employer consent to collect the information contained herein and use for the purpose specified. By signing below I also give consent to my insurance broker to provide the employer with the above-mentioned information. Signed: Signature*Print Name: First Name* Last Name* Address: Street Address* Address Line 2* City* State* Zip*
If you are offered and accept employment with Age in Place Home Care, in the interest of safety for all concerned, you will be required to have the last 3 years of your drivers record pulled. I, First Name* Last Name* , have been fully informed of the reason for this, and do hereby freely give my consent. In addition, I understand that the results of this test will become part of my record. I hereby authorize these results to be released to Age in Place Home Care. SELECT ONE OF THE FOLLOWING: * (Initial) I CONSENT TO HAVE THE LAST 3 YEARS OF MY DRIVERS RECORD REVIEWED Driver's License State: * Driver's License Number: * Last 4 digits of Social: * * (Initial) I DO NOT HAVE AN ACTIVE DRIVERS LICENSE * (Initial) I DO HAVE AN ACTIVE DRIVERS LICENSE BUT WILL NOT TRANSPORT CLIENTS. Date: Date* Name: First Name* Last Name* Signature: Signature* Age in Place Representative Name: First Name* Last Name* Age in Place Representative Title: * Age in Place Representative Signature: Signature* The information contained within this document is not shared with any third parties. The information is for record keeping and is kept in the employee's file during employment or as required by law. The information is used in the employee's confidential record of employment. The Employee, by signing this document gives the employer consent to collect the information contained herein and use for the specified purpose.
If you are offered and accept employment with Age in Place Home Care, in the interest of safety for all concerned, you will be required to take a urine test for drug and/or alcohol use. I, First Name* Last Name* , have been fully informed of the reason for this urine test for drug and/or alcohol (I understand what I am being tested for), the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record. If this test is positive, and for this reason I am not hired, I understand that I will be given the opportunity to explain the results of this test. I hereby authorize these test results to be released to Age in Place Home Care.Date: Date* Name: First Name* Last Name* Signature: Signature* Age in Place Representative Name: First Name* Last Name* Age in Place Representative Title: * Age in Place Representative Signature: Signature* The information contained within this document is not shared with any third parties. The information is for record keeping and is kept in the employee's file during employment or as required by law. The information is used in the employee's confidential record of employment. The Employee, by signing this document gives the employer consent to collect the information contained herein and use for the specified purpose.
Dear Age in Place Employee, The following items are required for employment with our company and payment will be your responsibility. Should be received by check or money order upon hire.Background Check ($10) Driver's Abstract ($14)The pre-employment testing, which include the Drug Screen & 2 Step PPD, will also be your responsibility; however, Age in Place will pay upfront for this testing and it will later be deducted from your check. The cost of the pre-employment testing will depend on which location you choose.I * understand the above information regarding the cost to me for my pre-employment testing and background check as well as driver abstract if necessary. Employee Print Name First Name* Last Name* Employee Signature Signature* Date: Date* Age in Place Representative Signature* Date: Date*
Click the link below and complete the questions for the WOTC.Work Opportunity Tax Credit
Please keep a copy of the confirmation code for your records.