Apply Online with Touching Angels


Touching Angels HealthCare
Applicant Information
         
         
Driver License State

Experience
Organization: Telephone: Contact Person: Dates Worked: Years Known May We Contact:
Contact Person Telephone Position/Title Dates Known Ver

Education
Name Location Major Graduate? End Date
Name Location Graduate? End Date

Availability
MonTueWedThuFriSatSun
From
To
Live-Ins - Being a Live-In means several consecutive days of care where the Caregiver stays at the care recipient's home for the entire number of days.

Skills and Preferences

Specialized Training

Additional Questions

Emergency Contact Information
Name Relationship Cell Phone Home Phone
CERTIFICATION AND RELEASE
I certify the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentation of facts will result in rejection from this application and/or discharge at any time during employment period. I authorize Touching Angels to verify any and all information contained within this application, 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 also understand that the use of illegal drugs is prohibited during employment and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment.“I certify that the facts contained in this application are true and complete to the best of my knowledge, and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein, and authorize the references and employers listed above to provide any information concerning my previous employment, and any other pertinent information they may have, personal or otherwise. I release the Company from all liability for any damages that may result from the legal utilization of such information. I also understand and agree that no representative of the Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA), HIPPA, or other relevant federal or state laws.”

RESTRICTIVE COVENANT
I agree not to do business directly with any individual or business entity that Touching Angels has introduced to me or by entering into employment with such individuals or businesses.




DO NOT WRITE UNDER THIS LINE - OFFICE USE ONLY
DATE STAFF NAME POSITION HIRED SALARY/WAGE REPORT DATE