Employment Application

Employment Application

Applicant Information

Are you a citizen of the United States?*

YESNO

If no, are you authorized to work in the U.S.?*

YESNO

Have you ever been convicted of a felony?*

YESNO

If yes, explain:

Education

Did you graduate?

YESNO

Did you graduate?

YESNO

Did you graduate?

YESNO

References

Please list three professional references.

Previous Employment

Responsibilities

May we contact your previous supervisor for a reference?

YESNO

Responsibilities

May we contact your previous supervisor for a reference?

YESNO

Responsibilities

May we contact your previous supervisor for a reference?

YESNO

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

PLEASE REVIEW APPLICATION CAREFULLY. PLEASE READ THE FOLLOWING AND SIGN THE APPLICATION IN THE SPACES PROVIDED BELOW. IF YOU HAVE ANY QUESTIONS, PLEASE SPEAK WITH THE HUMAN RESOURCES REPRESENTATIVE BEFORE SIGNING.

I understand that employment by NP Care Services Group and any of its companies is “at will.” This means that the employment relationship can be ended by me or by NP Care Services Group at any time for any reason with or without advanced notice and with or without cause. It also means that NP Care Services Group may revise and make exceptions to its policies, practices, handbooks, manuals, rules, procedures, and regulations, in whole or in part, at any time.

I further understand that acceptance of an offer of employment does not create a contractual obligation upon NP Care
Services Group to continue to employ me in the future or for any specific term. Notwithstanding the above, I understand that no representative of NP Care Services Group, except the president, has any authority to enter into any agreement of employment for a definite term. Any such agreement must be in writing and signed by the president.

If employed by NP Care Services Group, I agree to comply with all safety and health rules, company policies and procedures, and local, state, and federal laws pertaining to my employment. Although management makes every effort to accommodate individual preferences, organizational needs may make the following
conditions mandatory: overtime, rotating work schedule, or a work schedule other than Monday through Friday or normal business hours.

I understand and accept these as conditions of my employment should I be hired. I have reviewed this application carefully and I hereby affirm that my statements and answers to all questions on this application are true and correct and that I have not knowingly withheld any fact or circumstance that, if disclosed, would affect my application unfavorably.

I understand that any misstatement or omission of fact on this application may result in my application not being considered, and, if employed, may result in my immediate dismissal. I HAVE READ AND AGREE TO THE ABOVE TERMS AND CONDITIONS:

INVESTIGATION AUTHORIZATION By signing below, I hereby authorize NP Care Services Group to conduct an investigative report and/or reference check concerning all statements contained in my application for employment; to interview all employers, references, and other individuals and institutions to obtain information and opinions about me; and to conduct any other investigation that it deems appropriate.

Such investigation may include but is not limited to my education, employment history (except my current employer if I have so indicated above), character, general reputation, driving record, credit history, and criminal record.

In the event that I am employed by NP Care Services Group, I hereby authorize NP Care Services Group to answer any inquiries regarding my employment, conduct, qualifications, and reasons for leaving.

I understand that I have the right to request NP Care Services Group to disclose to me, completely and accurately, the nature and scope of the investigation. (Such a request must be made in writing to the human resources department within a reasonable time after you have completed and signed this authorization).

In exchange for being considered for employment, I hereby release NP Care Services Group, its employees, and agents, as well as any law enforcement agency, current or former employer, educational institution, credit agency, or any other individual providing information about me to NP Care Services Group, from any liability arising from disclosure of such information that is obtained during said investigation.