One Heart - Application for Employment

Application for Employment

Please read this statement completely and carefully before filling out this application.
One Heart is built upon a unique vision. Our vision is to create a better world. We believe in helping everyone. At One Heart we strive to work together in different ways to live our vision every day. If you are a person who believes in the same vision, then we would love for you to join our family.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.
Full Name *

First Name Middle Name Last Name
Current Address *

Street Address

Street Address Line 2

City State

Zip Code
Email Address *
Phone Number *

Emergency Contact
Name *
Phone *
Please enter a valid phone number.
Address *
Relationship *
Have you ever been convicted of a felony? Please answer honestly. Background checks are required and will be ran pre-employment. *

Yes No
If yes, please provide details *

Education
Add your education details starting from high school
Degrees/Certificates
Special skills or courses

Experiences
May we contact your current employer?

Yes No
Please fill out your past years of work history
Company
Job Title
From

Month Day Year
To

Month Day Year
Duties
Supervisor
Phone Number
Please enter a valid phone number.
Reason to Leave
Experience Verified?

Yes
Verification Date

Month Day Year
Date
Do you like to add more experiences?
Company
Job Title
From

Month Day Year
To

Month Day Year
Duties
Supervisor
Phone Number
Please enter a valid phone number.
Reason to Leave
Experience Verified?

Yes
Verification Date

Month Day Year
Date
Do you like to add more experiences?
Company
Job Title
From

Month Day Year
To

Month Day Year
Duties
Supervisor
Phone Number
Please enter a valid phone number.
Experience Verified?

Yes
Verification Date

Month Day Year
Date
Reason to Leave
Do you like to add more experiences?
Company
Job Title
From

Month Day Year
To

Month Day Year
Duties
Supervisor
Phone Number
Please enter a valid phone number.
Reason to Leave
Experience Verified?

Yes
Verification Date

Month Day Year
Date

Personal References
Please list 1 work reference and 2 personal references (References listed you must have known for 5 years or more)

CERTIFICATION AND RELEASE
CERTIFICATION AND RELEASE: *

I certify that I have read and understand the application note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
Application Verfied by:

Clear
Application Verification Date

Month Day Year
Date

Disclosure and Release: Search For arrests and warrants
In connection with my application for employment (including contract for services) with RH Care, I understand that a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment purposes will be conducted. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas:

Verification of social security number; current and previous residences; employment history including all personnel files; education including transcripts; character references; criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; birth records; motor vehicle records to include traffic citations and registration; and any other public records or to conduct interviews with third parties relative to my character, general reputation, personal characteristics or mode of living. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me to RH Care. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

I hereby release RH Care, the Social Security Administration, and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release. You may contact me as indicated below.

I hereby authorize procurement of consumer report(s)/investigative consumer report(s). I understand this authorization automatically expires 90 days from the date executed below. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for RH Care to procure consumer report(s)/investigative consumer report(s) at any time during my employment (or contract) period. I understand I have the right to revoke the authorization at any time, provided I do so in writing.
Print Name *
Date of Birth *

Month Day Year
Former Names & Dates Used
Social Security No *
Driver’s License No. & State *
Signature *
Date *

Month Day Year
Should be Empty:

Application for Employment

Disclosure and Release: Search For arrests and warrants