Employment Application

NOW HIRING FOR ALL POSITIONS.

Danny’s Home Health Care does not discriminate against anyone on the basis of race, color, national origin, disability, or age.

Other agency guidelines prohibit discrimination on the basis of creed, gender, sexual orientation, marital status, status with regard to public assistance or veteran status.

Name(Required)

First Middle Last

Current Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Mobile Phone(Required)

Home Phone

Email(Required)

Are you legally authorized to work in the U.S.?(Required)

Yes

No

Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H- 1B)?(Required)

If hired, verification will be required consistent with federal law.

Yes

No

Are you at least 18 years old?(Required)

If no, you may be required to provide authorization to work.

Yes

No

Do you have any criminal background history?(Required)

Yes

No

Please provide details of your criminal background history.(Required)

Do you have any relatives employed by this organization?(Required)

Yes

No

Have you worked for this Company before?(Required)

Yes

No

How did you hear about us?(Required)

Professional References

List three professional references (other than those listed as current/former supervisor) that we may contact.

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Company(Required)

Reference 2

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Company(Required)

Reference 3

First Name

Last Name

Email

Phone

Company

File Uploads

Resumes, Cover Letter, Certification, Awards, etc.

Please upload any information you'd like us to have with your application.

Drop files here or

Max. file size: 2 MB.

Additional Comments

Please comment on how your prior education and experiences qualify you for the type of employment you are seeking.

Please Read Carefully and Agree Before Signing

I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment.(Required)

I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment. I understand, where permissible under applicable state and local law, I may be subject to a pre- employment drug test after receiving a conditional offer of employment, and must receive a negative result for illegal drug use before being permitted to commence work with Company. I understand, where permissible under applicable state and local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with Company. I understand, where permissible under applicable state and local law, I may be subject to a pre-employment background check after receiving a conditional offer of employment to investigate my criminal background and other matters related to my suitability for employment.

Agree

Hidden

HIDDEN - I hereby certify that the information given by me is true in all respects.(Required)

I authorize Company and its representatives to contact my prior employers and all others (with the exception of my current employer), for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools and other persons named on this application to provide any information or transcripts requested.

Agree

I hereby certify that the information given by me is true in all respects.(Required)

I authorize Company and its representatives to contact my prior employers and all others (with the exception of my current employer), for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools and other persons named on this application to provide any information or transcripts requested.

Agree

Disagree

I authorize Company and its representatives to contact my current employer.(Required)

Yes

No

I certify that all of the above information is true and complete, and I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination regardless of the time elapsed before discovery.(Required)

Note: An offer of employment is conditioned upon complying with Company's requirements including, but not limited to, signing a consent to conduct a background investigation.

Agree

State Specific Notices

Massachusetts Applicants: IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITIES.

Maryland Applicants: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A POLYGRAPH EXAMINATION OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

Signature

I understand employment with Company is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.(Required)

I understand employment with Company is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

If employed, I understand that as a condition of employment that I may be required to agree to and sign a non-solicitation, non-disclosure, and/or other similar agreements. I also agree to notify the organization during the pre-employment process of any non-solicitation, non-disclosure, and/or other similar agreements that I may have already signed with current and former employers.

I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at-will, with or without cause, by either party (Company or me) without prior notice to the other, unless otherwise prohibited by law.

I understand that no representation, whether oral or written, by any representative or agent of Company, at any time, can constitute an implied or express contract of employment. I further understand no representative or agent of Company has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by an authorized representative.

I understand that the technical processing and transmission of the application, including my personal information, may involve (a) transmissions over various networks, including the transfer of this information to the United States and/or other countries for storage, processing and use by Company, its ffiliates, and their agents; and (b) changes to conform and adapt to technical requirements of connecting networks and devices. Accordingly, I agree to permit such parties to make such transmissions and changes, and hereby provide the necessary consent for the same.

Agree

Signature(Required)

I AGREE, AND IT IS MY INTENT, TO SIGN THIS EMPLOYMENT APPLICATION BY SIGNING IN THE BOX BELOW AND BY ELECTRONICALLY SUBMITTING THIS DOCUMENT TO COMPANY, I UNDERSTAND THAT MY SIGNING AND SUBMITTING THIS DOCUMENT IN THIS FASHION IS THE LEGAL EQUIVALENT OF HAVING PLACED MY HANDWRITTEN SIGNATURE ON THE SUBMITTED DOCUMENT.

Name

This field is for validation purposes and should be left unchanged.

NOW HIRING FOR ALL POSITIONS.

Position Information

Professional References

Reference 2

Reference 3

File Uploads

Additional Comments

Please Read Carefully and Agree Before Signing

State Specific Notices

Signature