Application

APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, non-job related medical conditions or disabilities, or any other legally protected status.

You can be assured that your information will be kept confidential with our Human Resources representatives and staff. If you feel more comfortable mailing in your application, you can download a copy of it by clicking here.

* Denotes required fields

RN Shift LPN Shift Infusion RN Assessment RN Trainer/Instructor RN Visit Nurse Home Health Aide Personal Care Aide Physical Therapist Occupational Therapist Speech Therapist Training Class PCA Coordinator Receptionist 

 Yes No I am 18 years of age or older

 Yes No

 Yes No

Position Held:

 Yes No

 Yes No

 Full Time  Part Time Per Diem  Temporary

 Yes No

 Yes No

 Yes No

 Yes No

If you answered "yes" to the above, please list your past 2 work experiences, and persons we may contact regarding your work performance and personal characteristics. Begin with your most recent (or current) employer. This information should be complete and include a phone number for each employer.

Employer #1

Employer #2

Education

 Yes No

Emergency Contact:

*I understand that if I am hired my initial employment will be on a 3 month introductory basis and that my employment at Wellness Home Care, Ltd. may be terminated, with or without cause or notice, at any time, at my option or that of the company. I understand that no management representative has any authority to enter into any agreement for continuing employment for any specific period of time or which is contrary to the foregoing.

I give Wellness Home Care permission to contact all or any of my previous employers and references and authorize them to provide all information requested. I authorize them to obtain, use and rely upon that information in relation to my application. I have provided truthful and complete responses to all inquiries in the application and understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal. If employed I will abide by Wellness Home Care's rules and regulations, which I understand are subject to change.

References:

Please provide up to three people that we can contact regarding your personal Characteristics.

Reference 1:

Reference 2:

Reference 3:

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 By checking this box I agree to the above statement.

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