Jas Links Healthcare Employment Application

  • Welcome to the Jas Links Healthcare Services Employment Application! We are very glad to know you are interested in working at our company. Please carefully read this application. Make sure the information you provide is complete and accurate. Also, please do not leave any blank spaces. 

    We look forward to working with you! 

    • Personal Information 
    • Gender*
    • Birth Date*
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    • Position applied for:*
    • Have you ever applied for employment with Jas Links Healthcare Services?*
    • Are you legally eligible for employment in the United States?*
    • Do you have reliable transportation?*
    • Have you ever been convicted of a felony?*
    • How did you learn of our company?*

    • Education 
    • Did you graduate?
    • Did you graduate?
    • Did you graduate?
    • Employment History 
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    • Start Date*
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    • End Date
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    • Start Date*
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    • End Date*
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    • Start Date
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    • End Date
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    • Professional References 
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    • Skills and Certifications 
    • Key Skills*
    • Do you have Gait Belt experience?*
    • Do you have Hoyer Lift experience?*
    • Are you ok with dogs?*
    • Are you ok with cats?*
    • Health Statement 

    • I, {fullName}, hereby attest that the state of my health is such that it will enable me to perform the duties of a health care professional. I further specifically attest that I am free of any and all potentially contagious diseases including, but not limited to those listed below:

      AIDS Anthrax Chickenpox Cholera
      Diphtheria Encephalitis Hepatitis (Types A, B, C) Influenza
      Leprosy (Hansen's Disease) Leptospirosis Malaria Whooping Cough
      Meningitis Mononucleosis Mumps Rabies
      Plague Poliomyelitis Psittacosis (Ornithosis) Smallpox
      Rocky Mountain Spotted Fever Rubella (Measles) Shigellosis Typhoid Fever
      Tetanus Tularemia Tuberculosis  

    • TB Targeted Medical Questionnaire

    • 1) Have you ever had a positive TB skin test or history of TB infection?*
    • 2) Have you ever had the BCG vaccine?*
    • 3) Do you have prolonged or recurrent fever?*
    • 4) Have you recently lost weight?*
    • 5) Do you have a chronic cough?*
    • 6) Do you cough up blood?*
    • 7) Do you have sweating at night?*
    • 8) Do you have any of the following risk factors which may substantially increase the risk of tuberculosis?*

    • Hepatitis Vaccine Requirement

    • I, {fullName}, acknowledge that I am at risk of exposure or have been unknowingly exposed to Hepatitis B as a result of my employment. It is my decision to:

    • *
    • Required Documents 

    • To work as a CNA or PCA in the state of Georgia, you must have the following documentation:

      • 2 forms of valid identification (i.e. state ID, driver's license, social security card, birth certificate, or passport)
      • CPR certification
      • TB test OR chest x-ray and TB screening
      • Auto insurance
      • Georgia CNA license (if applicable)

       

      Please note that it is your responsibility to submit updated documentation if/when they expire. 

       

      Attach your documents below.

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    • Disclaimer and Signature 

    • I, {fullName}, certify never having been shown by credible evidence (e.g. a court or jury, a department investigation, or other reliable evidence) to have abused, neglected, sexually exploited, or deprived a child or adult or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct.

       

      I, {fullName}, certify that the facts contained in this applicaiton are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

       

      I, {fullName}, authorize Jas Links Healthcare Services Inc. to contact each former employer, firm, or corporation. I authorize any of these persons to give all information concerning work-related items and I release all parties from liability for any damage that may result from furnishing same to you.

       

      I, {fullName}, also understand that if accepted by Jas Links Healthcare Services Inc., my employment is voluntarily entered into, and I am free to resign at any time. Similarily, Jas Links Healthcare Services Inc. is free to conclude my employment at any time.

       

      By signing, I acknowledge the above certifications and statement with agreement.

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