Olea Health Services Job Application

Olea Health Services Job Application

Please complete the application and competency test below to apply for a position with us.
Olea Health Services is an equal-opportunity employer. Federal and state laws prohibit discrimination in employment practices because of race, color, religion, age, sex, national origin, or handicap. No question on this application is asked for the purpose of limiting or excluding any applicant’s consideration for employment (because of his or her race, color, religion, age, sex, national origin, or handicap).
Full Name*

First NameMiddle NameLast Name
Email Address*
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Information provided will be used to determine applicant's eligibility through required background screening.
Date of Birth*

MonthDayYear
Date
Applying for Position*
Start Date

MonthDayYear
Date
What is your mode of transportation for work?*
How did you hear about Olea Health Services?
Name of Referral (if applicable)

References

Please provide us with two professional references (cannot be friends or family)
Company/Employer *

First NameLast Name
Company/Employer Phone Number*

Area CodePhone Number
Company/Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Held*
Start Date of Employment*

MonthDayYear
eg: XX-XX-XXXX
End Date of Employment*

MonthDayYear
ex: XX-XX-XXXX
Signature

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Today's Date

MonthDayYear
Date

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial, educational and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or individuals from all liability when responding to inquiries in connection with my application. In the event that I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge. You acknowledge that upon orientation you will be asked to read and sign the following: Employee acknowledgment of probation, transportation responsibility contract, confidentiality statement, personal health information pledge of confidentiality, policy on jobs, non-discrimination policy, anti-harassment policy, universal precautions, infection control, consent form to release physical medical examination and criminal background screening form, use of personal protective equipment, waiver of rights, safety of the patient's immediate environment, employee statement of commitment, voluntary substance testing, policy on patients progress notes, agency zero fraud tolerance policy, staff conflict of interest policy, and staff code of conduct/ethics.
Initials*

References