Enter Your Contact Information
Education and Qualifications
(start with most recent employer)
Current or Most Recent Employer
Please list three professional references, not related to you. These can
be personal contacts provided they have knowledge of your work experience.
Applicant's Statement Regarding Caregiving History
- I attest that I, the applicant, have never abused, neglected, sexually
assaulted, exploited or deprived any person nor have I subjected any person
to serious injury as a result of intentional or grossly negligent misconduct.
Waiver and Release of Information
I understand and agree that any consequential omissions or misrepresentations
made by me on this application will be sufficient cause for cancellation
of this application and/or termination by Homewatch CareGivers if I have
been employed. I understand that any offer of employment will be at the
will of Homewatch CareGivers and that the company reserves the right to
terminate my employment at any time, with or without prior notice and
that I am free to resign at any time with or without prior notice. I understand
that no representative of the company has the authority to make any assurances
to the contrary.
I, hereby authorize Homewatch CareGivers 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 the reasons for such termination. I also release Homewatch CareGivers
and its representatives from all liability from any damage that may result
from furnishing the same to you. This includes a criminal background history,
workers’ compensation investigation and/or Social Security check.
This may also include random drug testing.