Job Application Fields marked with an asterisk (*) must be filled out before submitting. How did you Hear of All About Home Care, LLC? * Position(s) Applying for: * HomemakerCNARNAdmin Contact Information First Name: * Last Name: * Current Address: * City and State: * Zip Code: * Phone: * Mobile Phone: * Email Address: * Employment History Employer #1 Employer#1 Company Name: * Employer#1 Start Date: * Employer#1 End Date: * Employer#1 Job Title: * Employer#1 Phone: * Employer#1 Duties: * Employer#1 Salary: * Employer#1 Supervisor: * Reason Left Employer#1: * May We Contact Employer#1? * YesNo Employment History Employer #2 Employer#2 Company Name: Employer#2 Start Date: Employer#2 End Date: Employer#2 Job Title: Employer#2 Phone: Employer#2 Duties: Employer#2 Salary: Employer#2 Supervisor: Reason Left Employer#2: May We Contact Employer#2? YesNo Education: High School: * High School City/State: * Graduated High School? * YesNo College: College City/State: Graduated College? YesNo Licenses: CNARN Other Licenses: Certifications: CPRHomemaker Other Certifications: Availability: Please list exact time you are able to work each day. (start & Stop times) Monday: * Tuesday: * Wednesday: * Thursday: * Friday: * Saturday: * Sunday: * Towns to which you are willing to travel: * BarringtonBristolJamestownLittle ComptonMiddletownNewportPortsmouthTivertonWarren Transportation: Do you have dependable transportation? * yesno Is your vehicle fully insured? * yesno Employment Reference#1 (NO Friends or Family) Reference#1 Name: * Reference#1 Company: * Reference#1 Relationship: * Reference#1 Phone Number: * Employment Reference#2 (NO Friends or Family) Reference#2 Name: Reference#2 Company: Reference#2 Relationship: Reference#2 Phone Number: Employment Reference#3 (NO Friends or Family) Reference#3 Name: Reference#3 Company: * Reference#3 Relationship: Reference#3 Phone Number: Employment Reference#4 (NO Friends or Family) Reference#4 Name: Reference#4 Company: Reference#4 Relationship: Reference#4 Phone Number: Conclusion: CERTIFICATION AND RELEASE: I certify that I have read and understand the application note on page one of this form 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 misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and herby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT. I ALSO UNDERSTAND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN ALL ABOUT HOME CARE, LLC AND I IS TERMINABLE AT-WILL, SO THAT BOTH THE COMPANY AND I REMAIN FREE TO CHOOSE TO END OUR WORK RELATIONSHIP AT ANY TIME FOR ANY OR NO REASON. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING. I have read and understood the above policy.