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First Name

Last Name

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Summary

Title:
Care Professional - Southern Saratoga County

ID:
1116

Contact Information

* First Name:

* Last Name:

* Address 1:

Address 2:

* City:

* State:

* Zip:

* Phone:

* Email:

Attachments

Resume:

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Cover Letter:

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WORK HISTORY

MOST RECENT EMPLOYER

* Are you currently working for this employer?

Yes No

* If yes, may we contact?

Yes No

* Company Name:

* City:

* State:

* Company Phone:

* Dates Employed - From:

* Dates Employed - To:

* Duties:

Reason for Leaving:

REFERENCES

If you are considered for a position, we may contact your references and would ask that you notify them in advance. Please do not list relatives or family/relations.

Professional References

Full Name

Phone Number

Best Time of
Day to Call

AM PM

Email

Relationship (No Relatives)

Number of
Years
Known

Full Name

Phone Number

Best Time of
Day to Call

AM PM

Email

Relationship (No Relatives)

Number of
Years
Known

Personal References

Full Name

Phone Number

Best Time of
Day to Call

AM PM

Email

Relationship (No Relatives)

Number of
Years
Known

Full Name

Phone Number

Best Time of
Day to Call

AM PM

Email

Relationship (No Relatives)

Number of
Years
Known

APPLICANT NOTE

NEC Care Inc. is an independently owned and operated Home InsteadÂ® franchise 12 Mountain Ledge Drive 518-580-1042.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents to verify any of the information included in this application. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):

* Date: