Form: Job Application

Job Application

"*" indicates required fields

Name*
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Type Of Employment Desired**
City*
State*
Zip Code*
Are you legally eligible for employment in this country?**
Proof of U.S citizenship or immigration status will be required upon employment
Are you able to meet attendance requirements of this position?**
Have you ever been convicted of any crime?**
Have you ever had substantiated abuse or neglect complaint?**

Employment History

List you up to four previous employers, assignments, or experience. List most recent first.

Experience

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City*
State*
ZIP Code*

Educational Background

Professional References

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to investigate all refrence and to secure additional information about me, if job related, I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. I also understand that a pre-employment phusical and drug screen may be required.

Release of Information (B)

Read carefully before signing.

I have read and do understand the statements contained herein and certify that they are true and complete without qualification.

Assured Family Services has the right to terminate my employment at any time if it discovers that I have provided incomplete, untrue or misleading answers in this application or any other document or form at any time during my employment.

I hereby authorize that previous employers or personal references contacted by AFS, in connection with this application fully respond to all inquiries concerning such previous employment and specifically waive prior written notice of disclosure of my personnel record information, including disciplinary reports, letters of reprimands or other disciplinary action. I also authorize educational institutions to release information relative to claimed degrees and achievements. In consideration of the acceptance of my application, I release AFS or previous employers and educational institutions of any claimed liability arising out of such response and disclosure.

In the event that I am employed by this agency, I agree to comply with all its orders, rules and regulations, and acknowledge that said orders, rules and regulations do not constitute terms of employment.

I hereby acknowledge that this application is for an employment of indefinite duration and understand that either AFS or I can terminate my employment and compensation, with or without cause, and with or without notice, at any time.

I understand that no one other than the Executive Vice President of AFS has the authority to make any agreement (oral, written or implied) or other representations.

Release of Information (A)

I understand and agree that, prior to contracting with persons who will be providing services to AFS' consumers, AFS will secure criminal history and driving record information and may require individual to complete a pre-employment physical examination using the information provided below:
Full Name*
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This field is for validation purposes and should be left unchanged.