• Ashur Home Care Employment Application

    Ashur Home Care Employment Application

    Fill the form below accurately indicating your potentials and suitability to job applying for. All prospective employees will receive consideration without discrimination because of race, color, creed, age, natural origin or handicap. All information provided herein will be kept confidential.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • Job Skills & Education

  • References

     Please list two (2) references that are familiar with your work life.

  • Reference 1

  • Format: (000) 000-0000.

  • Reference 2

  • Format: (000) 000-0000.
  • Was your last name different from your present name during the above listed jobs?*
  • Type a question
  • Do you have reliable transportation?

  • Employment

    List last two jobs you were employed at starting with the most recent
  • Most Recent Job*
  • Second Most Recent Job*
  • Have you ever been convicted of a crime in the past 10 years, barring employment in a Home Care and community support Agency?*
  • Are you capable of performing the duties set forth in the job description?*

  • Employment

  • I certify that the facts contained in this application are true and complete to the best of my knowledge and understand, that, if employed, falsified statements on this application SHALL BE GROUNDS FOR DISMISSAL.

    I Authorize complete investigation of all statements contained herein and herby give my full permission for the Agency to contact and fully discuss my background and history with all persons and entities listed above to give the Agency any and all information concerning my previous employment and any information they may have and release all former employees and others listed above from all liability for any damage that my result from furnishing the same to the Ashur Home Care Inc.

    I understand and agree that, if hired, my employment is for no definite period arid may, regardless of the date of payment of my wages and salary, be terminated at any time for any lawful reason, without prior notice and with or without cause.

    NOTICE REGARDING BACKGROUND INVESTIGATION
     

    A consumer report (background screening report) and/or an investigative consumer report which may include information obtained through personal interviews concerning your character, employment history, general reputation, personal characteristics, police record, education, qualifications, motor vehicle record, mode of living, and/or credit and indebtedness (can be removed if never seeking credit reports) may be obtained in connection with your application for and/or continued employment, contract for services or volunteer services with Ashur Home care inc.  A consumer report and/or an investigative consumer report may be obtained at any time during the application process or during your employment, contract for services or volunteer services with Ashur Home care inc.  You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report.  Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by Safe Hiring Solutions LLC, P.O. Box 186, Crawfordsville, IN 47933 888-215-8296. 

    By signing below, I hereby voluntarily authorize Ashur Home care inc to obtain either a consumer or an investigative consumer report about me from a consumer reporting agency and to consider this information when making decisions regarding my application for and/or continued employment, contract for services or volunteer services  at Ashur home care inc.  I understand that I have rights under the Fair Credit Reporting Act, including rights discussed above, and have received a Summary of My Rights Under the FCRA. This report may be delivered in either written or electronic form.

    This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period shall inquire as to whether or not applications are being accepted at that time.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
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