SZM DIGNITY HOME CARE

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Thank you for your interest In working for our agency

SZM Dignity Home Care Services is looking for qualified homecare professionals who are committed to
providing the highest quality for our home health care to clients in a professional and compassionate
manner

Application For Employment

JOB INTERESTS

Please Indicate your availability or interests below

EDUCATION

If you become an employee of this Agency you will be required to provide documentation providing your eligiblity to work in the USA

This does not if the conviction has been expunged, is contained in a sealed record, or was a juvenile conviction.

WORK HISTORY

REFERENCES

1st Reference

Conditions of Employmentent

* A condition of employment includes willingness on the part of the applicant or employee to agree to PPD test, Criminal History Investigation, Child Abuse Clearance, Competency Exam and Random Drug Screening.

* It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the SZM Dignity Home Care Services, if I have been employed. Furthermore, I understand that just as I am free to resign anytime, SZM Dignity Home Care Services reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of SZM Dignity Home Care Services has the authority to make any assurances to the contrary. .

In accordance with Title VI of the Civil Rights Act of 1964 and it implementing regulation, The agency is an EQUAL OPPORTUNITY EMPLOYER and WILL NOT DISCRIMINATE AGAINST RACE, COLOR, SEX, CREED, NATIONAL ORIGIN OR COMMUNICABLE DISEASE AS DEFINED IN SECTION 504 OF TITLE VI. In accordance with Section 504 of the Rehabilitation Act of 1973 nd its implementing regulation Supreme Home Healthcare, LLC WILL NOT DIRECTLY OR THROUGH CONTRACTUAL OR OTHER ARRANGEMENTS , DISCRIMINATE ON THE BASIS OF HANDICAP. In accordance with the Age Discrimination Act of 1975 and its implementing regulation the agency WILL NOT DIRECTLY OR THROUGH CONTRACTUAL OR OTHER ARRANGEMENTS, DISCRIMINATE ON THE BASIS OF AGE in the provision of services, unless age is a factor necessary to the normal operation or the achievement of any statutory objective. In accordance with the Americans with Disabilities Act of 1992 (42 USC 12101) and its implementing regulations, (private employer with more than 25 agency personnel), the agency WILL NOT DIRECTLY OR THROUGH CONTRACTUAL OR OTHER ARRANGEMENTS, DISCRIMINATE ON THE BASIS OF DISABILITY . A disability is a physical or mental impairment that substantially limits a major life Activity, or for which there is a record of impairment or which causes the individual to be regarded s impaired. .

The Information that I have given is true and accurate to the best of my knowledge .