Our client is an equal opportunity employer. Applicants will be considered regardless of race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the Human Resource Representative.

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.

BACKGROUND RELEASE NOTIFICATION & REQUEST FORM

I, {fullName}, understand that, in connection with my application for or employment by HOMEWATCH CAREGIVERS a background check is required by the Employer that may include information as to my character, work habits, performance and experience, along with reason for termination of past employment from previous employers. I give consent to the employer to download AHCA clearing house document.

I further understand that the Employer is requesting information concerning my motor vehicle operation history and criminal conviction history from various states, private and insurance sources, along with other available public records. Homewatch CareGivers may also deduct the cost of background checks and drug screenings from the employee’s paycheck if the employee does not remain with the company for the entire introductory period of 90 days. This fee can be up to $100 which may be deducted from the final paycheck to return the cost of fingerprinting, background checks and drug screenings that the company has paid to employ the caregiver.

I voluntarily and knowingly authorize each and every present and past employer or supervisor, college, university or other institute of education; administrators; law enforcement agency, state agency, federal agency, finance bureau/office; credit bureau; collection agency; private business; military branch or the National Personnel Records Center; personal reference; and/or other persons to give records of information they may have concerning my criminal conviction history, health, character, and employment, or any other information requested by the Employer or its authorized agent.I voluntarily, knowingly and unconditionally release any named or unnamed reporting party from any and all liability resulting from the furnishing of any information to either the Employer or its authorized agent.

This release and notification shall be valid for my term of employment from the date indicated next to my signature. A photographic or facsimile transmitted copy of this authorization shall be as valid as the original.The purpose of this release is to notify you that a consumer report will be compiled in the course of consideration for your employment. This release form must be maintained for a minimum period of twenty-five (25) months per the Fair Credit Reporting Act but will remain in effect for the length of employment as stated above.

Please acknowledge your review and understanding by signing below: