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  • Renaissance Job Application

    Renaissance Job Application

    Personal Information
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  • Job Applicant Attestation

    please read and review carefully before signing
  •          I certify that all the information have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) terminate further consideration of this application or (ii) immediately discharge me from the employer's service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all the information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims may have regarding the employer, its agents, employees, representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations, or organizations, or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in the employment and no question on this application is used for the purpose of limiting or excusing any application from consideration for employment on a basis prohibited by applicable local, state, or federal law. I understand that this job application will remain current for a period of 30 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for any specified period of definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to contrary and that no implied oral or written agreements contrary to he foregoing expressed language are valid unless they are in writing and signed by Administration or the President. I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and the federal immigration laws require me to complete an I-9 form in this regard. hereby attest that I have read the foregoing Job Applicant Statement in full. I clearly understand and accept all terms mentioned herewith. I agree to provide my last seven (7) years of employment history, including periods of unemployment, starting with themost recent and working backwards in time. I understand that incomplete information could disqualify me from further consideration.

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  • Employment History

    • Work Experience Information 
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    • I hereby authorize * to release all information regarding my employment to Spring Hills / Renaissance Home Health Care by any means necessary and release from liability the organization and individuals named in the foregoing Employment Verification Request.

      Full name:* Signature:   *   

    • Previous employer information #2 
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    • Previous employer information #3 
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    • Previous employer information #4 
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    • Business Reference #1 
    • Business Reference #2 
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  • Education History

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  • Notification and Agreement

  •      I certify that all answers given by me are true, accurate and complete, I understand that the falsification, misrepresentation, or omission of fact on this application (or any other accompanying or required documents) will be cause for denial or employment or immediate termination of employment, regardless of when or how discovered. Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed. It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law. I authorize the investigation of all statements and information contained in this application. I authorize and release from all liability anyone supplying such information and I also release the employer from all liability that might arise from performing an investigation. If hired, I agree to abide by all of the company rules and regulations, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance, or otherwise change all policies, procedure, benefits, or other terms or conditions of employment. No representative or agent of the Company has the authority to enter to enter into any agreement for employment for any specified period or to make any change in any policy, procedure, benefit or other terms of conditions of employment other than in a document signed by the CEO, or to make any agreement contrary to the foregoing.

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  • NEW YORK STATE DEPARTMENT OF HEALTH

    The purpose of this form is to obtain consent from the subject individual for fingerprints and criminal history record information pursuant to Article 28-E of the Public Health Law and Section 845-b of the Executive Law.
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  • Additional Information

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  • Home Health Aid Competency Test

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