Career : Lotus Home Health Care

Lotus Home Healthcare Services

State Licensed & Medicare Certified

Career Form

Join Our Dynamic Team!

It is this facility’s policy to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, or disability.

You can download a form and FAX Us: Download here OR fill the form below:

Are You at Least 18 Years Old? yes no
Select Full Time Part Time Part Time Per Visit Pool
Shift Day Night Evening W/E
If you are not a US Citizen, have you the legal right to remain permanently in the US? Yes No
Have you been convicted of a crime (excluding misdemeanors and traffic offenses) and/or released from confinement following a conviction for any criminal offense within the past 7 years? Yes No
Are you presently charged with any violation of the law other than traffic violation? Yes No
Educational History

High School

College

In case of an emergency notify:

Work History - Attach an additional sheet listing other work experience pertinent to the position for which you are applying if the space below is insufficient

Compnay 1

OK to Contact Supervisor Yes No

Compnay 2 (optional)

OK to Contact Supervisor Yes No

Compnay 3 (optional)

OK to Contact Supervisor Yes No

PERSONAL REFERENCES

ATTACH DOCUMENT

Please review and accept
In making application for employment:
· I certify that the information in this application is true and complete for all practical purposes. It may be verified by the facility or any affiliate. Should a position be offered and later it is found that the information is significantly untrue, incomplete, or misrepresented, I understand and agree that the facility or its affiliates are relieved of all commitments, financial or otherwise pertinent to employment, and that I am subject to immediate discharge without recourse.
· I understand that an investigative report may be made by a consumer reporting agency to include information as to my character, general reputation, personal characteristics, and mode of living, whichever may be applicable. If such an investigative report is made, I understand that I will receive notice that such report has been requested, and that I will have the right to make a written request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.
· I understand and agree that if I am offered employment by the facility, my employment will be for no definite term and that either I, or the facility will have the right to terminate the employment relationship at any time, with or without cause, and with or without notice. I also understand that this status can only be altered by a written contract of employment which is specific as to all material terms and is signed by me and the Administrator of the facility.
· I understand, if I am an unlicensed person who has direct patient contact, that the agency will perform a criminal history check per State Regulations.

Release: I hereby authorize any prior employers to provide such information concerning my employment with them as may be requested, and also authorize the Registrar/Placement Office of all educational institutions attended to release an official copy of my transcript and, if available, faculty appraisals. I also authorize any appropriate licensing board to release full information concerning my license status and my license history