Trusted Care, LLC | Employment Application

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EMPLOYMENT RECORD/EXPERIENCE

Present/past beginning with your most recent.
List personal caregiving experience if you do not have any professional experience*
May we contact your present employer?*

NoYesNo, not at this time
Current Employer*

CompanySupervisor Name & TitlePhone #EmailPosition Held
Current Employer Address*

Street Address

Street Address Line 2

CityState

ZIP
Employment start date*

MonthDayYear
Employment end date*

MonthDayYear
Last Salary*
Description of duties*
Reason for leaving*
Employer 1

CompanySupervisor Name & TitlePhone #EmailPosition Held
Employer 1 Address

Street Address

Street Address Line 2

CityState

ZIP
Employment start date

MonthDayYear
Employment end date

MonthDayYear
Last Salary
Description of duties
Reason for leaving
Employer 2

CompanySupervisor Name & TitlePhone #EmailPosition Held
Employer 2 Address

Street Address

Street Address Line 2

CityState

ZIP
Employment start date

MonthDayYear
Employment end date

MonthDayYear
Last Salary
Description of duties
Reason for leaving

REFERENCES

List below the names, addresses, and contact numbers of (2) persons who can attest to your responsible and reputable character. The persons must not be related by marriage, blood, or in a vested business interest.
Referee 1*

Full NameRelationshipPhone #EmailCompany
Referee 1 Address*

Street Address

Street Address Line 2

CityState

ZIP
Referee 2

Full NameRelationshipPhone #EmailCompany
Referee 2 Address

Street Address

Street Address Line 2

CityState

ZIP
Referee 3

Full NameRelationshipPhone #EmailCompany
Referee 3 Address

Street Address

Street Address Line 2

CityState

ZIP

1. I understand that the accuracy and completeness of my statements will be relied upon by Trusted Care, LLC. I authorize investigation of all statements contained in this application and permit Trusted Care, LLC to obtain any transcripts, records or documents pertaining to my background and business experience. Sources for this information may include court record repositories, departments of motor vehicle (DMV), past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied. I also agree to release Trusted Care, LLC from any liability arising there from and understand that any misstatements, omissions or false statements made by me may be cause for dismissal.*

I agree
2. I understand Trusted Care, LLC is committed to maintaining a drug and alcohol free workplace consistent with applicable state and federal laws and regulations. As an applicant for employment or a current employee of Trusted Care, LLC I specifically agree to not use, possess, be under the influence of, and/or sale of alcohol and illegal drugs at the workplace. Workplace is defined as any residence, facility, or vehicle where personal care services are provided.*

I agree
3. I understand as an applicant for employment or a current employee of Trusted Care, LLC, I may be required to take a drug test. I further acknowledge that if my drug test is positive, I am disqualified from employment from Trusted Care, LLC. I further understand that if I am employed with Trusted Care, LLC and quit or terminated with cause within 90 days of my employment the amount of the background check, DMV check, and training will be deducted from my last payroll check. *

I agree
4. If any employment relationship is established, I also understand that I retain the right to terminate my employment at any time and that Trusted Care, LLC retains a similar right.*

I agree
5. I acknowledge my understanding that statements which may be contained in policies, practices, handbooks and other company materials do not create any guarantee of employment. Any promise to the contrary will only be relied upon by me if they are in writing and signed by an authorized company official.*

I agree
6. I understand that the company has the right to modify, amend or terminate policies, practices, benefit plans and other company programs within the limits and requirements imposed by law. *

I agree
6. I understand that clicking the SUBMIT button below contents all of my information provided in this application to be accurate to the best of my knowledge and will hereby serve as my signature for this application to Trusted Care, LLC for consideration of employment.*

I agree, checking this serves as my signature
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Trusted Care, LLC :: Employment Application