Employment Application

Please list your work experiences beginning with your most recent job held. If you were self-employed, please note.

How would you rate yourself on your experience with the following aspects of caregiving?
1 = No Experience 2= Some Experience 3= Good Experience 4= Excellent Experience

PLEASE READ CAREFULLY In exchange for the consideration of my job application by EXTENSION OF YOU HOME CARE, I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other EXTENSION OF YOU HOME CARE company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of EXTENSION OF YOU HOME CARE, or otherwise change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the head of EXTENSION OF YOU HOME CARE. Both the undersigned and EXTENSION OF YOU HOME CARE may end the employment relationship at any time, without specified notice or reason. If employed, I understand that EXTENSION OF YOU HOME CARE may unilaterally change or revise their benefits, policies, and procedures and such changes may include reduction in benefits.
I also understand that (1) EXTENSION OF YOU HOME CARE has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment might be based on the successful passing of job related physical examinations.
I understand that, in connection with the routine processing of my employment application, EXTENSION OF YOU HOME CARE may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, EXTENSION OF YOU HOME CARE will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.
I hereby authorize EXTENSION OF YOU HOME CARE to request and receive from all prior employers within one year of the date of this application, any and all pertinent information concerning my prior employment and its termination, including reasons for such termination. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give EXTENSION OF YOU HOME CARE permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release EXTENSION OF YOU HOME CARE from any liability as a result of such contact.
I further understand that my employment with EXTENSION OF YOU HOME CARE shall be probationary for a period of 60 days, and further that any time during the probationary period or thereafter, my employment relation with EXTENSION OF YOU HOME CARE is terminable at will for any reason by either party.
I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE, AND COMPLETE.
(signatures here) EXTENSION OF YOU HOME CARE is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, age, or disability. We assure you that your opportunity for employment with this company depends solely on your qualifications.