Authorization
I personally, completed this form honestly and accurately. By my signature below, I promise that I have personally completed this application. I declare under penalty of perjury that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for my dismissal from employment if discovered at a later date. I understand that any job offer is conditional based on the satisfactory review of my qualifications including any and all background or drug screening which may be required.
Authorization to obtain information
I voluntarily and knowingly authorize any present or past employer; supervisor; administrator; educational institution; law enforcement agency; state, local, or federal agency; credit bureau; collection agency; private business; military branch; the national personnel records center; personal reference; and/or other persons; to give records or information they may have concerning my criminal history, motor vehicle report, educational history, licensing, employment (including character, earnings history and reasons for termination) or any other information requested by the company requested to determine my eligibility for employment. CT state agencies would also be used to verify your employment eligibility
Constant Care Home Care Agency 1164 Burnside Ave, East Hartford CT 06108 Phone: 860-997-6929Info@constantcareathome.org https://constantcareathome.org
Release
I voluntarily waive all recourse and release any company, individual or organization from liability for complying with any request from the company or agents of the company (including any consumer reporting agency) to obtain any information from any source whatsoever relating to my application for employment. I further release the company or any individual within the company regarding the use any information received which may have bearing on my application for employment.
Notification and compliance with rules
I agree to immediately notify the company if I should be convicted of a crime while my job application is pending, or during my employment if hired. If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies and procedures of the company. I certify that all of the information provided by me on this Application is true and accurate.
Continuous Education and In -service
I agree to complete the following trainings (HIPAA, Safety in Community, Pre-Cautions when traveling, Electrical Safety etc) prior to my start date as well as any continuous education in the form of In-services or online studying to enhance my performance at my job.
By signing below, you agree to the terms of employment above.