Employment 

Opportunities

Specify what days you're available (must be willing to work one or two weekends a month IF NEEDED)

Professional references - List at least two persons (other than relatives or past employers) who have knowledge of your skills and character.

Please list your work experiences beginning with the most recent job.

NAME AND ADDRESS OF EMPLOYER                                  

NAME AND ADDRESS OF EMPLOYER                                  

NAME AND ADDRESS OF EMPLOYER            

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS FORM

I certify that the information contained in this application is complete and true to the best of my knowledge and that I have not knowingly withheld any facts or information that would affect my employment. I hereby authorize Amakes Quality Home Care to verify the information contained herein and to investigate education, personal history, and criminal history. I understand that any falsification or omission of material and / or information requested may result in denial of employment or termination if I am already employed. Upon my termination, I authorized the release of information on my work.

I hereby authorize my former employers to release any and all information regarding my previous employment to assist this agency in determining my suitability for employment.

I further understand that my employment will be at will, that is, I would reserve the right to terminate my employment when I choose, and that my employer would reserve the same right.