* Required fields

Tender Care Employment Application
Date: 12.11.2018
Position Information
* Position to apply for:
* Work Desired:
*I will work in these cities:
Personal Information
* First Name: Middle Name: * Last Name:
* Social Security Number:
* Street Address:
Apartment Number: * City:
* State: * Zip Code:
* Day Phone: Evening Phone:
* Email Address:
* Emergency Contact: * Emergency Number:
General Information
* Have you ever applied for a job with TenderCare in the past? If so, please give the date of application and the position you applied for. Give your name at the time, if different from current name. Details:
(Maximum characters: 150) You have characters left.
* Have you ever been employed by TenderCare in the past? If so, please list dates of employment, position(s) held, and state your name while employed, if different from current name. Details:
(Maximum characters: 150) You have characters left.
* If hired, will you be able to work during the regular days and hours required for the position(s) for which you are applying? If no, please explain. *All Employees must work every other weekend. Will this be a problem for you?* Details:
(Maximum characters: 150) You have characters left.
* Are you capable of adequately performing the necessary functions of the job(s) for which you are applying? If no, please explain. Details:
(Maximum characters: 150) You have characters left.
* Have you ever been suspected, charged or convicted of an offense, misdemeanor/crime, or released from prison in the past 10 years? NOTE: A yes answer does not automatically disqualify you from employment since the nature of the offense, date, and type of job for which you are applying will be considered. If yes, please explain. * Details:
(Maximum characters: 150) You have characters left.
*Have you ever abused, neglected, sexually assaulted, exploited, or deprived any person? Have you subjected any person to serious injury as a result of intentional or grossly negligent misconduct?
*Do you have a valid driver's license, auto insurance and your own transportation? (NOTE: Having a driver's license and insurance is essential to this job because you are required to make home visits to patients' homes, unless you are applying for a clerical position) State:
*Do you have all the necessary licenses and professional certification(s) listed in the job announcement, job advertisement, or job description to perform the job(s) for which you are applying? If no, please explain. Details:
(Maximum characters: 150) You have characters left.
Education Information
SCHOOLS ATTENDED NAME OF SCHOOL AND LOCATION DID YOU GRADUATE? DEGREE, DIPLOMA OR CERTIFICATION GRADE POINT AVERAGE MAJOR COURSE OF STUDY
High School If not, highest grade completed: N/A N/A
Technical, Vocational, Business, Military training.
College or University
Graduate School
Professional Seminars
References (Must not be former Employers or Relatives)
Name:
Address:
Phone Number:
Occupation
Name:
Address:
Phone Number:
Occupation
Name:
Address:
Phone Number:
Occupation
Employment History - Present and Former
*May we contact your former employers:
Employer #1
Company Name: Company Address:
Company City: Company State:
Company Zip:
Job Title: Job Duties:
Payrate Per Hour:
Employment Dates:(Month/Year) Start Date: End Date:
Supervisor: Supervisor's Phone:
Reason for leaving:
Name if different while employed:
Employer #2
Company Name: Company Address:
Company City: Company State:
Company Zip:
Job Title: Job Duties:
Payrate Per Hour:
Employment Dates: (Month/Year) Start Date: End Date:
Supervisor: Supervisor's Phone:
Reason for leaving:
Name if different while employed:
Employer #3
Company Name: Company Address:
Company City: Company State:
Company Zip:
Job Title: Job Duties:
Payrate Per Hour:
Employment Dates: (Month/Year) Start Date: End Date:
Supervisor: Supervisor's Phone:
Reason for leaving:
Name if different while employed:
Legal Information
Please read carefully before submitting this application.
NOTE: TYPING YOUR NAME AND SUBMITTING THIS DATA IS YOUR ACKNOWLEDGEMENT AND ACCEPTANCE OF THE STATEMENT BELOW

I promise that the information provided in this employment application and accompanying resume (if any) is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for my dismissal from employment, if discovered at a later date. I agree to immediately notify the company if I should be convicted of a crime while my application is pending, or during my period of employment, if hired.

I authorize the investigation of all statements contained in this application (and accompanying resume, if any). I also authorize the company to contact my present employer (unless otherwise noted in this application form), past employers, and listed references. I understand that the company may request an investigative consumer-reporting agency that includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that the investigative consumer report may involve personal interviews with my neighbors, friends, relatives, former employers, schools and others. I also understand that under the Fair Credit Reporting Act I have the right to make a written request to the company within a reasonable time, for the disclosure of the name and address of the consumer reporting agency, so that I may obtain a complete disclosure of the nature and scope of the investigation.

Date: 12.11.2018 * Signed: