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Home
About
Services
- Durable Medical Equipment
Fees
Careers
- Job Openings
Contact
- Privacy Policy

Careers

Are you looking to join our team and make a positive difference in the lives of many people? Please fill out the form here and we will get back to you as soon as possible!

Personal Information

Date *

Name *

Social Security # *

Your Email *

Present Address

Street *

City *

State *

Zip *

Permanent Address

Street

City

State

Zip

Phone # *

If you are under 18, can you furnish a work permit? YesNo

Employment desired Full TimePart TimeTempSeasonal

Position

Date you can start

Salary

Are you employed now? YesNo

Have you ever applied to this company before? YesNo

Are you on layoff and subject to recall? YesNo

Would you travel, if required? YesNo

Will you relocate if job requires it? YesNo

Will you work overtime, if required? YesNo

Are you able to meet the attendance requirements of this position? YesNo

Have you ever been bonded? YesNo

Have you ever been convicted of a felony in the past 7 years YesNo

Driver’s license number

State

Education

Academic

Currently Attending

Name and location of School

# of years Completed

Did you Graduate?

Subjects Studied

Last Completed

Name and location of School

# of years Completed

Did you Graduate?

Subjects Studied

Trades of Business

Currently Attending

Name and location of School

# of years Completed

Did you Graduate?

Subjects Studied

Last Completed

Name and location of School

# of years Completed

Did you Graduate?

Subjects Studied

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with this company

Previous Employment

(1)

Date Month and Year

From

To

Name and address of employer

Salary

Job

Reason for Leaving

(2)

Date Month and Year

From

To

Name and address of employer

Salary

Job

Reason for Leaving

(3)

Date Month and Year

From

To

Name and address of employer

Salary

Job

Reason for Leaving

References: Give the names of three persons not related to you to whom you have known at least 1 year

Name

Address

Phone

Yrs Acquainted

List any foreign language(s) and check the box that best describes your skill level.

Language

Read and Write

Read and speak

Speak only

In case of Emergency notify

Name *

Address *

Relationship

Phone *

Conditions of Employment – please read carefully

Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on company premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes willingness on the part of the applicant or employee to agree to physical examination, polygraph and/or substance testing , if required by the company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy will result in dismissal.
It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service, if I have been employed. Furthermore, I understand that just as I am free to resign anytime, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.
I give the employer the right to investigate all police, driving, and personal records and references, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.
Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation , and failing settlement in mediation, to binding arbitration. Unless otherwise agreed , a mediation and arbitration designated by staff professionals will govern any mediation and arbitration. The parties will select the mediator or arbitrator from the designated company. Panel of mediators and will notify the designated company, in writing, to initiate the selection process. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act. 9 U.S.C. Section 1 – et se q. The parties hereto stipulate that this agreement involves matters affecting interstate commerce.
This application is current for 60 days. At the conclusion of this time , if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application.

Signature of Applicant *

Date *

AGENCY MANAGEMENT NOTES :

At Home Health & More, we currently provide non-medical in-home services to assist with a wide array of activities of daily living, non-medical transformation services, and companion and respite care services. CALL TODAY!

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