Employment Application


     
First Name *  
Last Name *  
Address *  
City * Phone *
State * Email *
Zip Code *   (* Fields are required)
Are you employed now?
May we contact your present employer?
Are you available to work: Full Time Part Time Temporary
On what date would you be available to work?
Are you prevented from lawfully becoming employed in this country
because of Visa or Immigration Status?
(Proof of citizenship or immigration status may be required upon employment.)
Are you on a lay-off and subject to recall?
Can you travel if a job requires it?

EMPLOYMENT EXPERIENCE
Start with your present or last job.
Include military service assignments and volunteer activities.

Job Title/Job Duties DATES
PAY RATES

Job Title/Job Duties DATES
PAY RATES

Job Title/Job Duties DATES
PAY RATES

Job Title/Job Duties DATES
PAY RATES

SPECIAL SKILLS AND QUALIFICATIONS
Summarize special skills and qualifications acquired from employment or life experience:
         
EDUCATION: ELEMENTARY HIGH COLLEGE GRADUATE / PROFESSIONAL
School Name:
Years Completed
Diploma / Degree
Describe Course of Study
Honors Received:
 

APPLICANT'S STATEMENT:

I certify that the answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment.

In the event of employment, I understand that false or misleading infomation given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide all rules and regulations of Freedom Independent Home Care, Inc.

 

Equal Employment Opportunity:

It is our policy to seek and employ the best qualified personnel and to provide equal opportunity for the advancement of employees. It is Freedom Home care’s intention to administer all of our personnel policies in a manner that will not discriminate against any person because of race, color, religion, age, sex, marital or veteran status, national origin, ancestry, disability, on-the-job injuries, or any other legally protected status, unless it is a bona-fide occupational requirement reasonably necessary to the operation of our business.