Online Job Application Form

Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Format: (000) 000-0000.

Applied Position

Earliest Possible Start Date

Date

Hours available:

Have you ever been convicted of a crime other than minor traffic offense?*

If yes, provide explanation.

Have you ever applied with Shine Adult Care, LLC in the past?

Are you related to anyone being provided services by Shine Adult Care, LLC

If yes, list name and relation.

Are you eligible to work in the US?*

Documentation is required prior to being offered a position.

Provide documentation type you can provide for citizenship.

Highest Level of Education *

Some positions might require a transcript.

Provide school name(s), location and major if applicable.*

Work History*

Provide Name, Address, Position, Supervisor and way to contact. If no resume please years of employment.

Please provide three professional or personal references. Excluding relatives.*

Upload Resume

Any Other Documents to Upload

You can share certificates, diplomas etc.

I understand and agree that:

1. Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of or, if employed, termination of employment.
2. The company will make a thorough investigation of my entire work and personal history and may verify all data given in my application, related papers, or oral interviews. I authorize such investigation and the giving and receiving of such information. I understand that falsification of data so given, or any other derogatory information discovered as a result of this investigation may prevent my being hired or, if hired, my subject me to immediate dismissal.
3. My position or employment is “at will” and may be terminated by this company at any time without liability for wages or salary except such as may have been earned at the date of such termination. If requested by management at any time, I agree to submit to search of my person or of any personal space that may be assigned to me, with cause, and I hereby waive all claims for damages on account of such examination, at company expense, at any time to determine if I am physically fit for the position I am to perform, and I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of the position for which I am being considered prior to beginning services or employment or in the future during my service provision or employment with the company.
4. My position may not begin until I have attended new provider orientation and attain certification for completion of all training required of privileging.
5. This is an application for service provision in which a contract will be provided or in the case of employment, no employment contract is being offered.
6. If I am employed, such employment is for an indefinite period of time and the company can change wages, benefits, and conditions at any time.
7. If I am accepting a contract position, the terms of the contract will be reviewed as necessary.
8. I must meet all eligibility requirements for work in the United States and have documentation to prove citizenship, permanent residency (“green card”), or current work visa status.

Certification of Application

I hereby certify that all statements made in this application and my attachments to it are true.I understand that any misstatement, misrepresentation, or omission of fact may be cause for my application not to be considered; or if I have been employed, may be cause for my immediate dismissal. I authorize the President/CEO of Shine Adult Care LLC., or theirdesignee to verify information contained in this application and attachments. I further authorize anyone who has such information to release it. I further understand that any offer of employment is conditional upon passing a physical examination, drug test, criminal background check, and driving record check.

I have received and agreed to abide by the above stated policies.

Signature*

Prior to extending employment agreement we must have all the following documents in your file in addition to the necessary training. If you do not have these documents on hand, please begin obtaining them.

*When you turn in this application you must at minimum give copies of your Social Security Card and Driver’s License* for background checks.

1. Social Security Card (MUST be the card issued by Social Security) – If you have lost your card, please reapply at Social Security and attach verification provided by Social Security that a new card has been requested. Once the card is received, it MUST be provided to Shine Adult Care, LLC.

2. Driver’s License (Current and valid) or State issued identification card. If transportation is a position function, if transportation is not required for the position you are applying for you do not have a Driver’s License.

3. Auto Insurance Declarations Page showing amounts of Vehicle Insurance coverage in the event that transportation is to be a job function.

4. CPR and First Aid Certification (CPR/First Aid cards or certificate)

5. High School diploma or equivalency – Verification of completion of at least high school or GED (copy of diploma, signed statement from school official, high school transcript, college diploma/transcripts, teaching certification, etc.) employment cannot begin without receipt of this information.

Note: If you have a college degree or for QP’s, a copy of the college transcript is required.

6. Alternatives to Restrictive Interventions training — EBPI, CPI or other approved training.

Cover Letter

Please do not exceed 200 words.

Application for Employment