Job Application Optimum Home Care Agency 2007 Sassaus Ln, Apex, North Carolina 27523 Optimum Home Care Agency is an equal opportunity employer. This application wil not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative. Please fill out all of the sections below: Applicant Information Applicant Name: Address: City, State and Zip Code: Telephone Number: Email Address: Date of Application: Employment Position Position (s) applying for: How did you hear about this position? What days are you available for work? What hours or shift are you available for work? If needed, are you available to work overtime? On what date can you start working if you are hired? Do you have reliable transportation to and from work? Personal Information Are you 18 years of age or older? Yes No Are you a U.S. citizen or approved to work in the United States? Yes No What document can you provide as proof of citizenship or legal status? Yes Do you have any condition which would require job accommodations? Yes No Job Skills/Qualifications Please list below the skills and qualifications you possess for the position for which you are applying: (Note: Optimum Home Care Agency complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) Education and Training High School Deatils Name Location (City, State) Year Graduated Degree Earned College/University Name of School Location (City, State) Year Graduated Degree Earned Vocational School/Specialized Training Name of School Location (City, State) Year Graduated Degree Earned Military: Are you a member of the Armed Services? What branch of the military did you enlist? Additional Information: Additional Skills AT-WILL Employment The relationship between you and the Optimum Home Care Agency is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Optimum Home Care Agency. No representative of Optimum Home Care Agency has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President. Text Submit Your message was successfully sent! We will reply to you shortly. OK
