This application is used to evaluate your qualifications for employment with Bethel Home Healthcare, LLC and does not constitute an employment contract. Please complete all applicable sections fully and accurately. Any false or misleading information may result in disqualification from consideration or termination of employment if discovered later. All qualified applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, or any other status protected by law. Pre-employment drug testing may be required.

Job duties may vary by client and may include, but are not limited to, medication assistance, meal preparation, housekeeping, transportation to community and medical appointments, and basic bookkeeping.

JOB RELATED SKILLS

WORK HISTORY

Work Style Assesement

CERTIFICATION AND RELEASE:  I certify that by submitting this form, I have read and understand the applicant note on page one (1) of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment if requested. I understand that this application is not a contract of employment. My employment is contingent upon confirmation of credentials and successful completion of drug test or criminal background check. I also understand that if hired, regardless of any oral presentations to the contrary, the employment relationship between Bethel Home Healthcare LLC., and myself is terminable at-will, so that both the company and I remain free to choose to end out work relationship at any time for any or no reason. Any changes in this employment relationship must be made in writing. My signature below acknowledges that I have read, understand, and agree to the above disclosure. I also understand that due to the nature of the business, no amount of work can be guaranteed.