EMPLOYEE APPLICATION - DISCOVER HEALTH AT HOME

Thank you for becoming a part of the Discover Health at Home team! We appreciate your dedication to providing quality care to our clients. Please fill out the following information and upload the required documents:
Position Applying For:
Position Applying For (Choose One):*

Medical DoctorRegistered NurseLicensed Practitioner NursePhysical TherapistOccupational TherapistRespiratory TherapistSpeech TherapistHome Health AideCertified Nursing Assistant
Personal Information:
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you over 18 years of age or older?*

YesNo
Are you authorized to work in the United States?*

YesNo
What documentation can you provide as proof of citizenship or legal residency?*
Documents to Upload:
Professional License:*

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Driver's License or Identification:*

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Social Security Card:*

Cancelof
Accommodations:
Do you have any conditions that will require accommodations? Please describe.*
Criminal Background:
Have you ever been convicted of a criminal offense, felony, or misdemeanor?*
Professional Reference:

Please provide one professional reference
Name*
Relationship*
Telephone Number*
Email*
example@example.com
Bank Account Details:
Account Number*
Bank Name*
Routing Number*
Tuberculosis Test:*

Cancelof
Physical Examination Report:*

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Please ensure that all documents are clear and legible for verification purposes. Thank you for your cooperation.
Signature:*

Clear
Date:*

MonthDayYear
Date
Criminal Background Check Consent:
I consent to a criminal background check. I understand that there will be a criminal background check conducted by Discover Health at Home in connection with my application for employment. I understand this background check may include, but is not limited to, criminal history, employment verification, education verification, and driving record checks. I authorize the release of this information to Discover Health at Home for employment purposes.
Signature:*

Clear
Date:*

MonthDayYear
Date
Employment Agreement:
I understand that my employment with Discover Health at Home is at-will. I acknowledge that my employment can be terminated at any time, for any reason, or without cause, or without notice by Discover Health at Home. No representative of Discover Health at Home has the authority to enter into any agreement contrary to the foregoing employment relationship. I understand that no oral or written statements or representations regarding my employment can alter my employment status, except for a written statement signed by the CEO and either our Executive Vice President, Chief Operations Officer, or the company's President.
Signature:*

Clear
Date:*

MonthDayYear
Date
We are an Equal Opportunity Employer (EEOC).
Should be Empty:

Position Applying For:

Personal Information:

Documents to Upload:

Accommodations:

Criminal Background:

Professional Reference:

Bank Account Details:

Criminal Background Check Consent:

Employment Agreement: