APPLICATION FOR EMPLOYMENT

Mercy Home Care is an equal Opportunity Employer. Employment offers are made on basis of qualifications, and without regard of race, sex, religion, national or ethnic origin, disability, age, veteran status or sexual orientations.

Please complete this employment application form for consideration. We strongly suggest proof-reading your application before clicking the submit button. We look forward to working with you!

PERSONAL INFORMATION

POSITION

EDUCATION AND TRAINING

EMPLOYMENT HISTORY (Begin with Most Recent Employment)

APPLICATION DISCLAIMERS

Authorization to Release Information

I have applied for a position with Mercy Home Care. I have been requested to provide information for their use in reviewing my background and qualifications. Therefore, I hereby authorize the investigation of my past and present work character, education, military and employment qualifications.

I authorize the release of my information to Mercy Home Care whether the information is of record or not, and I do hereby release all persons, agencies, firms, companies, etc., from any damages resulting from providing such information.

This authorization is valid for 180 days from the date below. Please keep this copy of my release request in your files.

Consent for Drug/ Alcohol Screen Testing

If you are offered and accept employment with Mercy Home Care, in the interest of safety for all concerned, you will be required to take a urine test for drug and / or alcohol screening.

I have been fully informed of the reason for this urine test for drug and/or alcohol screening. I fully understand what I am being tested for, the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record.

If this test is positive and l am not hired. I understand that I will be given the opportunity to explain the results of this test.

I hereby authorize these test results to be released to:

Mercy Home Care

MERCY HOME CARE -IS AN EQUAL OPPORTUNITY EMPLOYER

Applicant Acknowledgement

I certify that the information in this application is accurate, current and complete. I understand that incorrect statements or omission may result in disqualification from further consideration or termination of employment.

I authorize Mercy Home Care to investigate my employment history, credentials and to obtain any relevant information (including a criminal background check) needed to make an employment decision.
I authorize Mercy Home Care to disclose this application along with any information about me obtained through reference checks or during the course of the interview process for state, federal, contractual or accreditation audit purposes.
I also authorize Mercy Home Care to disclose any of my performance Appraisals, disciplinary record, or skills test for the same purpose as above.
I release Mercy Home Care and any individual or entity providing information to Mercy Home Care from all liability for any damages from the disclosure of this information.

I also understand and agree that:

• Passing a medical examination and / or participating in a post-conditional offer medical screening may be required. If medical restrictions cannot be reasonably accommodated. I may not be hired, or if hired, employment may be terminated.
• Subject to applicable state laws, Mercy Home Care reserves the right to conduct drug screening and testing for reasonable suspicion at anytime during employment and as a pre-employment requirement. Any violation of this policy shall result in an applicant not being hired or an adverse employment action up to including immediate termination. Mercy Home Care has the right to change this policy at any time as it requires.
• I understand that nothing contained in this employment application or in granting of an interview creates an employment contract between Mercy Home Care and me for either employment or for the providing of any benefit. No promises regarding employment have been made to me. If an employment relationship is established, I understand that my employment will be terminable at will", that I will have the right to terminate my employment at any time.
• I understand that should I become employed by Mercy Home Care my work assignment, schedules and / or work locations are subject to change according to the needs of the business and the clients of Mercy Home Care.