• Snug & Comfort Home Care Application

  • INSTRUCTIONS: If you need help filling out this application form or for any phase of the employment process,please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

    APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Care Services agency. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body may be required prior to employment.
  • Personal Information

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  • Availability

    Due to the nature of the business, no guarantee can be made as to the schedule orthe amount of hours worked.
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  • Preferences


  • Job Related Skills

  • Education


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  • Work History

    Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.
  • Most Recent Employeer

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  • Second Most Recent Employeer

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  • Third Most Recent Employeer

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  • Security

    Please be sure to complete the attached Authorization to do a criminal and motor vehicle background check.
  • REFERENCES (Do not include relatives)

    Please complete all three references. Yourapplication will not be considered unless three references are provided. Since we will contact these references, please notify them in advance. If we are unable to reach all 3 references, you will be asked to provide additional references.
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  • CERTIFICATION AND RELEASE:

    I certify that I have read and understand the applicantnote on page one (1) of this form and that the answers given by me to theforegoing questions and the statements made by me are complete and true to thebest of my knowledge and belief. I understand that any false information,omissions or misrepresentations of facts in this application may result inrejection of my application or discharge at any time during my employment. Iauthorize the company and/or its agents, including consumer-reporting bureaus,to verify any of this information including, but not limited to, criminalhistory and motor vehicle driving records. I authorize all persons, schools,companies and law enforcement authorities to release any information concerningmy background and hereby release any said persons, schools, companies and lawenforcement authorities from any liability for any damage whatsoever forissuing this information. I release this company from any liability which mightresult from making such investigations. I also understand that the use ofillegal drugs is prohibited during employment. I am willing to submit to drugtesting to detect the use of illegal drugs prior to and during employment. I understand that this application is not a contract of employment. Myemployment is contingent upon confirmation of credentials and successfulcompletion of drug test or criminal background check. I also understand that ifhired, regardless of any oral presentations to the contrary, the employmentrelationship between Snug and Comfort LTD, and myself is terminable at-will, sothat both the company and I remain free to choose to end out work relationshipat any time for any or no reason. Any changes in this employment relationshipmust be made in writing. My signature below acknowledges that I have read,understand, and agree to the above disclosure. I also understand that due tothe nature of the business, no amount of work can be guaranteed.
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