Senior Home Companions
Overview of Services
Assisted Living Care
Skilled Care Support
New Client Inquiry
Apply At SHC
Senior Home Companions
SHC: Caregiver Employment Application
Address Line 2
State / Province / Region
ZIP / Postal Code
Do you possess a valid driver's license?
Expiration Date of License
Type and year of automobile
Have you ever submitted an application before?
How did you hear about Senior Home Companions?
Why are you interested in Employment with us?
Why would you be a good companion/caregiver?
I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the previous questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, law enforcement authorities and others to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability, which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT. I ALSO UNDERSTAND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN SHC, LLC AND MYSELF IS TERMINABLE AT-WILL, SO THAT BOTH THE COMPANY AND I REMAIN FREE TO CHOOSE TO END OUR WORK RELATIONSHIP AT ANY TIME FOR ANY OR NO REASON. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING.
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