EVA CARE INC. Employment Application1937 Pontius Ave. Los Angeles, CA 90025 Programs services and employment are available equally to everyone. The company does not discriminate on the basis of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, or sexual orientation of any person, in its employment practices. Please inform the Human Resources Department if you require reasonable accommodation to the application or interview.General InformationFull Name *Last, First MiddleEmail *Position Applying for *Location (you may choose more than one location) FairfieldFillmoreFullertonJacksonMontclairPasadenaSan BernardinoSan JoseSouthgateHomehealth Travelling TherapistAddress Street AddressApt, Suite, Bldg. 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YesNoNote Company will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of Article 9 of Chapter XVIII of the Los Angeles Municipal Code; Ordinance 184652.Employment DesiredDate available to start Rate of expected pay Shift available AnyAMPMEmployment desired Full-TimePart-TimePer Diem/On CallTemporaryHow many hours per week are you able to work Weekend Availability SaturdaySundayN/AEducationHigh School City/State: # of Years Completed Did you graduate? YesNoCollege/University City/State # of Years Completed Did you graduate? YesNoDegree Major Others City/State # of Years Completed Did you graduate? YesNoDegree Major Previous Employment (Begin With The Most Recent Position)I. Date of Employment From To Position(s) Held Company Address Phone Supervisor Title Responsibilities Starting Title Ending Title Reason for Leaving May we contact this employer for reference? YesNoII. Date of Employment From To Position(s) Held Company Address Phone Supervisor Title Responsibilities Starting Title Ending Title Reason for Leaving May we contact this employer for reference? YesNoIII. Date of Employment From To Position(s) Held Company Address Phone Supervisor Title Responsibilities Starting Title Ending Title Reason for Leaving May we contact this employer for reference? YesNoProfessional ReferencesReference 1 Name Occupation Phone Reference 2 Name Occupation Phone Reference 3 Name Occupation Phone Statement of Certification I certify that my answers are true and complete to the best of my knowledge, I authorize you to make such investigations and inquiries of my personal employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in dismissal. I understand and agree that if I am employed, my employment will be at-will, meaning that either party can end the employment relationship at any time and for any or no reason. I hereby acknowledge and authorize the facility to conduct a background check for hiring procedures. I understand that if offered a position, I may be required to submit to a pre-employment drug screen and a medical examination performed by a qualified health professional (for selected positions, pursuant to State and Federal law). I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of a drug screen or medical examination may result in the withdrawal of any employment offer or termination of employment if already employed. I have read and reviewed the information provided in this application and the above statements. By signing this application I certify that I understand all parts of it and have answered all questions completely and fully.Electronic Signature (type in your full name) Date VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
