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EMPLOYMENT APPLICATION

You can also email an electronic copy of your resume (word or pdf format) to mocon@intrinsicarehealth.com 

* Accuracy in completing this Application is important for employment consideration.

*This Application will be kept active for ninety (90) days.


Personal Information

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Address
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If Yes, what are the dates of employment?


EDUCATIONAL BACKGROUND


References

Please provide the name of three (3) business/work references, not related to you, whom you have known at least one year. If not applicable, please list three(3) school or personal references that are not related to you.

Reference 1


Reference 2


Reference 3


Employment History

Please provide the following information from your past and current employers, assignments and volunteer activities. 

Most Recent Employer


Next most recent employer


Next most recent employer


I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misinterpretations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time.

I give the employer the right to contact and obtain information from all references, employers, educational institutions and to verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representative for seeking, gathering, and using such information.

The employer does not unlawfully discriminate applicant's employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration from employment on a basis prohibited by a local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by authorized officer.

I understand that it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for reasonable accommodation as required by the ADA and Section 504 of the Rehabilitation Act.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization. In consideration of my employment, I agree to conform to Vital Wellness Home Health Agency's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice at any time by Vital Wellness Home Health, Inc.

I have read and fully understand the foregoing and seek employment under these conditions.

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