Forever Family Homecare. Employee Application Form

Full Name:*

Full Name

Phone Number:*

Please enter a valid phone number.Format: (000) 000-0000.

Present Address:*

Street Address

CityState

Zip Code

If Under 18, Please List Age:*

Position Applying For:*

Desired Salary:*

How Many Hours Per Week:*

Have You Been Convicted Of A Crime: (If Yes Please Explain)*

Date Available To Start:*

Full-TimePart-TimeFull Or Part-Time

YesNo

Driver’s LicenseNumber:*

Issuing State:*

Have You Been In Any Accidents In The Past 3 Years:*

Have You Had Any Moving Violations In The Past 3 Years:*

Any Military Background:*

Are You A Member Of The National Guard:*

YesNo

References:
Please List 3 References:

Reference 1
Name:First Name*   Last Name*
Position:Type a label*Company:Type a label*
Address:Telephone:Phone Number*

Reference 2
Name:First Name   Last Name
Position:Type a labelCompany:Type a label
Address:Street AddressTelephone:Phone Number

Reference 3
Name:First Name*   Last Name*
Position:Type a label*Company:Type a label*
Address:Street Address*Telephone:Phone Number*

Education History:

High School: Type a label* Yrs:Type a label
Trade School:Type a label* Yrs:Type a label
College:Type a label* Yrs:Type a label

Work History:
Employer 1
Company Name:Type a label   Company Telephone:Phone Number
Company Address:   Street AddressSupervisor Name:Type a label
Start Date:DateEnd Date:Date

Employer 2
Company Name:   Company Telephone:
Company Address:   Supervisor Name:
Start Date:End Date:

Employer 3
Company Name:Type a label   Company Telephone:Phone Number
Company Address:   Street AddressSupervisor Name:Type a label
Start Date:DateEnd Date:Date

In exchange for the consideration of my job application by Forever Family HCS, (hereinafter called “the Company”), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Forever Family HCS, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Forever Family HCS may end the employment relationship at any time, without specified notice or reason.
I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise
indicated), references, and others, and hereby release the Company from any liability as a result of such contract.
I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I further understand that my employment with the Company shall be probationary for a period of sixty (60)days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Applicant Signature*

Date*

Date

Forever Family Homecare. Employee Application Form

APPLICATION FORM WAIVER