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COMPLETE HOME HEALTH, INC.

An Equal Employment Opportunity Employer

Notice to applicant: We appreciate your interest in the company and assure you we are interested in your qualifications. A clear understanding of your background and work history will aid us in placing in the position that best meets your qualifications and may assist us in future upgrading. It is to your advantage to give complete and detailed answers to the questions in this application. 

1) The company does not discriminate in its employment practices on the basis of race, color, religion, sex, national origin, age or disabilities. Questions on this application relating to such characteristics will be used for government reporting purpose.

2) Many positions with the company, including secretarial and clerical positions, require some physical ability and the ability to lift moderate weights. Please consider this.  We will make reasonable accommodations in altering the requirements of the position when possible.  However, because of the nature of our services and business necessity, we are limited in what we can do.

3) The company has an extensive non-smoking policy that prohibits smoking while at work, during working hours, or while providing services for the company and /or its clients. Applicants who smoke may want to inquire about the policy before completing this application.

  RN               LPN                OTHER _____________________

__________________________________________________________________________________________

NAME: (LAST)                                              (FIRST)                                       (MIDDLE-SPELL OUT)

__________________________________________________________________________________________

ADDRESS (STREET)                                           (CITY/STATE)                                                  ZIP

__________________________________________________________________________________________

HOME PHONE                          CELL PHONE                      BEEPER                              OTHER          

POSITION DESIRE:        

1) ____________________

2) ____________________

3) ____________________    

I UNDERSTAND THAT THE POSITION FOR

WHICH I AM APPLYING IS CONSIDERED

TO BE AND IS CLASSIFIED AS PART TIME.

PROFESSIONAL LICENSE:

RN:__________        LPN:__________

PT:___________       SP:__________

OT:___________        MSW:__________

CNA:__________

 

Do you authorize inquiry from your present employer?

                            YES     NO

Do you authorize inquiry from your previous employers?

                            YES  NO

                                                                                                                              

 

 

 

 

 

 

 

 

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