* Required Information

PERSONAL INFORMATION

EMPLOYMENT HISTORY




EDUCATION

Name & Location of school Degree or Certification Number of Years Attended Did You Graduate?
GED / High School
Trade School
College
Graduate

REFERENCES
List three professional references, (business or work, not relatives) that you have known for atleast one year. List at least one previous supervisor.

Full Name Company Best phone number to reach them Years acquainted Relationship


AUTHORIZATION
I understand that KindHearted Healthcare INC. is making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination if employed. I authorize Kindhearted Healthcare INC. to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to Kindhearted Healthcare INC. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original. Pre-employment testing may be required (drug testing, background checks, physical examinations, motor vehicle checks). Testing may be an applicant or employer-paid based on the employer. I understand that any offer of employment may be withdrawn if drug tests are positive and/or if a condition is discovered for which no reasonable accommodation can be made. I understand that this application is current for 60 days. At the conclusion of this time, if I have not heard from Kindhearted Healthcare INC. and still, wish to be considered for employment, it will be necessary to complete a new application. I understand that if hired, employment is at-will, regardless of the employer, and may be terminated by myself or Kindhearted Healthcare INC. at any time, with or without cause or notice, for any reason or no reason.
By entering your name, you agree to accept the terms of the above document with an electronic signature

I agree

I do not agree


You must agree to accept the terms of the document in order to submit an application

I consent to the collection, use, storage, and processing of my personal and, where applicable, health-related information, including any data I submit on behalf of others, for the purpose of evaluating or fulfilling my request made through this form. I understand this will be handled in accordance with the Privacy Notice.