• EMPLOYMENT APPLICATION

    EMPLOYMENT APPLICATION

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  • EMPLOYMENT REFERENCES

    Please Provide 2 Professional References
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  • PERSONAL REFERENCES

    Please Provide 2 Personal References
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  • CONDITIONAL OFFER OF EMPLOYMENT

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  • Items Needed for Orientation:

    • 1-9 Documentation
      • USA Passport/Employment Card; or
      • Drivers License/Identification Card & SSN Card/Birth Certificate. 
    • TB Skin Test Results within 1 year/QuantiFERON Results
      • If positive TB Results/QuantiFERON, Negative chest X-Ray required. 
    • Immunization Records or Complete Declination Form 
    • Drivers License and Copy of Insurance Document  (ONLY if eligible to transport clients)
  • Thank you for your interest in emoloyment with Vital Homecare.

    We are presenting you with a conditional offer letter of employment contingent upon negative upon negative drug screen results, approved background check and favorable references. 

    Please feel free to call us with any questions. by signing below, you agree that you understand that the offer of employment is conditional and that you are being offered variable hourly employment with no gurantee of hours. 

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  • Background Check: Authorization and Release

    Authorization to Conduct Criminal Background Reports
  • , understand that as part of the home care employment process, Vital Homecare must complete a background check, which includes criminal history searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years; and sex offender registry searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided. Additional checks can be run for any of the following: criminal record, sex and violent offenders record, employment verification, education verification, license verification, motor vehicle records, personal/professional reference, medical suitability, drugs & alcohol abuse.

    • I authorize all state and federal agencies, persons and organizations that may have information relevant to this research to disclose such information to Vital Homecare or its authorized agents.
    • I understand that this authorization is to be part of the written and signed employment application.
    • I also understand that I do not have to give authorization for a background check but if I don’t give permission, my employment application will not be processed further.
    • I further authorize that a photocopy of this authorization may be considered as valid as the original.
    • I hereby certify that all statements on this form are true and correct to the best of my knowledge and belief. I understand that employment with Vital Homecare is contingent upon successful completion of a background check.
    • I further understand that NC General Statute Chapter 131E Article 16 dictates the requirements of homecare employees regarding under what circumstances I may be denied employment as a direct care worker.
    • I further understand that it is my responsibility to notify the agency if I have not lived in North Carolina consecutively for 5 years. (No breaks where I have lived out of state even for short periods of time.
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  • The following is for identification purposes only to perform the background check:

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