Application For Employment Form
Mission Statement: The mission of Reliable Supportive Home Care LLC is rooted in a set of core values and our
unique purpose is draped around reliability and an excellent support team of empathetic Direct
Support Professionals and a phenomenal heritage of great customer service and excellence.
Please check off the qualifications for employment:
This application must be completed in its entirety with a verification signature and date.
A resume may be attached to further expand on qualifications, but it does not absolve
the requirement of a completed application. How Did You Hear About Reliable Supportive Home Care? If Yes, Please Give Entity and Dates:
Do You Have The Legal Right To Work In The United States?
Do You Have Documention To Support The Above Statement
Do You Have A Valid Driver's License?
What Military Skills Do You Possess That Would Be An Asset For This Position? If Yes, Please Explain: If Yes, Please Explain Professional License and/or Certifications List Any Professional License(s) License(s) Number(s) If Yes, Please Explain List Any Relevant Certifications Skills and Qualifications Please list any other qualifications, professional organizations, and/or volunteer experiences that are applicable to the position for which you are applying for. you may exclude and whose name would indicate the race, religion, creed, color, national origin or ancestry of it's members Criminal Background Disclosure
Please Check Any If Boxes If They Apply To You:
I also, understand that prior to an offer of employment at Reliable Supportive Home Care LLC will conduct a criminal background check within the State of Pennsylvania and search the nurse aide registry and employment misconduct registry to determine eligibility for employment. Authorization and Release of Information I hereby give Reliable Supportive Home Care LLC, and any of its affiliates and divisions, the right to thoroughly investigate my past employment, education, police record, activities, and I release from all liability all persons, companies, and corporations supplying such information. I indemnify RSHC against any liability which might result from conducting such an investigation. I understand that any false answers or statements or implications made by me in this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between RSHC and myself for either employment, contract work, or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon RSHC unless made in writing by the President and Chief Executive Officer. I acknowledge by signing below that I fully understand that I am applying to the agency as a contracted Lifesharing provider and not one particular home or individual. Thank you for your application. We will review it and get in touch with you soon!