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Be part of our team!

We work hard to find a Long Term assignment for you.

– Competitive and flexible rates

– Incentive Bonus

– Holiday Rate (Top 7 holidays)

– Part Time/ Full time

– Direct Deposit Payments

– Cash Advance Programs

– Continuous Training

– Health Plan

– 401K Retirement Plan

– Workers Compensation

– Paid Time Off

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Employment Application

Education

High School (City, State required)

School Name

Major/Minor

Graduate? Yes No GED

Type of Degree

Grade Point Average

School / College #2 (City, State required)

School Name

Major/Minor

Graduate? Yes No

Type of Degree

Grade Point Average

School / College #3 (City, State required)

School Name

Major/Minor

Graduate? Yes No

Type of Degree

Grade Point Average

Employment (List all employment during the past 10 years)

(1) Employer

Employer's Name

Street Address

City

State / Zip Code

Job Title

Supervisor's Name/Title

Supervisor's Telephone No.

From (mm/yy)

To (mm/yy)

Reason for Leaving

(2) Employer

Employer's Name

Street Address

City

State / Zip Code

Job Title

Supervisor's Name/Title

Supervisor's Telephone No.

From (mm/yy)

To (mm/yy)

Reason for Leaving

(3) Employer

Employer's Name

Street Address

City

State / Zip Code

Job Title

Supervisor's Name/Title

Supervisor's Telephone No.

From (mm/yy)

To (mm/yy)

Reason for Leaving

U.S. Military (Active Duty including Reserve or National Guard Service)

Branch of Service

Rank

Type of Discharge

Special Skills / Training Acquired in Service

Background Information

When completing this section, do not disclose information regarding convictions that have been judicially erased, sealed, expunged, eradicated, impounded, or dismissed. Do not disclose information regarding juvenile court convictions or minor traffic violations. A conviction record does not automatically bar you from employment. All job-related circumstances surrounding convictions will be considered.

1. In the past seven (7) years, have you been convicted of, pled "guilty" or "no contest" to, been imprisoned, or on probation or parole for any felony? Yes No

2. In the past seven (7) years, have you been convicted of, pled "guilty" or "no contest" to, been imprisoned, or on probation or parole for any misdemeanor? Yes No

3. Do you currently have any charges pending? Yes No

4. Are you currently on probation? Yes No

5. If you answered Yes to any of the questions above, please explain completely:

Business References

Name

Job Title

Address

Telephone No.

Name

Job Title

Address

Telephone No.

Name

Job Title

Address

Telephone No.

Abuse Investigation

Have you ever been investigated for abuse, neglect, or domestic violence? Yes No

If Yes, explain:

Authorization and Understanding

Release of Prior Personnel Information — By signing this application, I agree that all of the information now or later given by me in support of my application for employment is true and complete. I understand that you may verify any of the information concerning my employment, education, credit, or medical history with the appropriate individuals, organizations, or governmental agencies. I authorize the release of any information you need without requiring prior notice to me. I understand that no verification of my credit history or a "consumer report" under the Fair Credit Reporting Act may be undertaken without my express written authorization in a separate document. I agree that any false information in support of my application may subject me to discharge at any time during my employment.

At-Will Employment Status — I agree that either party may terminate the employment relationship, with or without cause, at any time, for any reason, and I further agree that this agreement may only be changed by the President of the Company, in writing, directed to me personally, and signed by the President. I agree to be bound by the other rules, regulations, and terms and conditions of employment as they change from time to time. I further agree that my employment is conditional upon satisfactory completion of documentation required by the Immigration Reform and Control Act of 1986, and, if applicable, the results of a pre-employment physical.

Release for Reference Checks — I authorize the Company to contact my previous employers for work-related references.

Release for Background Screening — I authorize the Company to verify any information that I provide in connection with my employment. I release the Company and its authorized representatives of all liability resulting from the use of background information about me for employment purposes.

I have read and agree to all of the above authorizations *

Applicant's Signature (type full name) *

Date *

State Licensed, Bonded and Insured HCO #074700123

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Employment Application

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