Gentle Hearts Home Care Inc Job Application
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Last Name *
First Name *
Positon applied for *
Application Date *
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full address  *
Are you at least 18 *
Do have access to public transportation  *
Do u have a car *
Do you have a driver's  license  *
Driver's License  *
Have you been convicted of a crime other than a traffic law other than a traffic violation within the last 10 years  *
If yes, please explain *
training certificate # *
Available  *
Required
Please state times available
The name of your High School *
Address of High School *
Years of High School and did you graduate  *
Did you go to college  *
If so where and what did you major and did you graduate and how long were you in collage for 
Work experience from - to  *
Company name and address *
Company Phone Number *
Position  *
Describe your work  *
Superiors and title  *
Last wage *
Reason for leaving  *
References name Address occupation no family   *
AND phone no, Numbers of years know  *
Skills Inventory (check that all apply) *
Required
Please state experience and training for all above *
Are you capable of preforming in a reasonable manner the activities involved in the job or occupation for which you have applied? A description of the activities involved in such a job is attached. Do not answer this question unless you have been informed about the requirements of the job for which you are applying. *
I certify that the answers given herein are true and complete to the best of my knowledge.

I understand that, in the event of employment, false or misleading information given in this application or interview may result in discharge. 

I authorize the company, as part of its evaluation of my suitability for employment, to contact all school officials, references, and my previous supervisors to secure information concerning my skills, character and ability. 

I understand and agree that, if I am employed, I will be an at-will employee and the company may terminate my employment at any time and for any reason.
Applicant signature *
Date *
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DD
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YYYY
All persons shall have the opportunity to be considered for employment without regard to race, colo,r religion, national origin, age, disability, (which includes history of mental disorder, mental retardation, learning disability, physical disability, blindness, atypical heritage cellular or blood trait) gender, marital status, liability for service and armed forces of the United States, veteran's status, citizenship, sexual orientation, or any other characters are protected by the applicable federal or state laws. The company will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant or employee with a disability unless a combination would impose an undue hardship on the operation of our business.
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