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If you have lived at the above address for less than 12 months.
If you have lived at the above address for less than 12 months.
If you have lived at the above address for less than 12 months.
If you have lived at the above address for less than 12 months.
Proof of citizenship or right to work status will be required at time of hire.
If your response to any of the 3 preceding questions was “YES”, give dates, places & nature of each such conviction or pending charge. (The existence of a conviction or pending charge will not necessarily preclude you from employment, the nature of the crime and its relationship to the position applied for, the degree of rehabilitation of the applicant and the time elapsed since the crime or release from confinement will all be considered.
The Centers for Medicare and Medicaid Services (CMS) issued a COVID vaccination mandate requiring all health care workers to be fully vaccinated by March 15, 2022, and the first of any two-dose vaccine by February 14, 2022, unless exempted for religious or medical reasons. Since Dunbar Village is certified by CMS, all Dunbar Village employees are required to be fully vaccinated by this deadline unless otherwise exempted. In the event of exemptions, necessary precautions must be taken including but not limited to the use of an N-95 mask while in the building.
Being a Live-In means several consecutive days of care where the Caregiver stays at the care recipient's home for the entire number of days.
Include name & location, major studies, graduated/grade completed for 1) High School, 2) College, 3) Nursing School, 4) Special Schooling or training.
Include type, state, date issued, and number.
List all previous employers for whom you have worked for during the last six years with salary of each employer (start with most recent). Explain any lapses between times when employed. Include: 1) Name & Address of Employer, 2) Month/Year Started, 3) Month/Year Ended, 4) Salary, 5) Position, 6) Supervisor, 7) Reason for Leaving
Include names, relationships, phone numbers, and email addresses.
Include names, relationships, phone numbers, and email addresses.
I certify the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentation of facts will result in rejection from this application and/or discharge at any time during employment period. I authorize Village Care at Home, LLC to verify any and all information contained within this application, 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 hereby 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 and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment.
I agree not to do business directly with any individual or business entity that Village Care at Home, LLC has introduced to me or by entering into employment with such individuals or businesses.