True Care Home Services Inc.

Application for Independent Contractors


 
True Care Home Services, Inc.
5201 Blue Lagoon Drive
Suite 800 Miami, FL 33126
Office: (305) 632-8577
Fax: (786) 329-6452
Web site: www.truecarehomeservicesinc.com

 

APPLICATION FOR INDEPENDENT CONTRACTOR AGREEMENT

 

General Information

First Name:

Last Name:

Home Phone:

Cell Phone:

Email:

Address:

Are you legally entitled to work in the U.S.?:

 

Position

Position or Type of Employment Desired:

Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation? :

Will Accept::

Shift::

Salary Desired:

 

Availability

Date Available to Start:

Monday: Monday Availability:

Tuesday: Tuesday Availability:

Wednesday: Wednesday Availability:

Thursday: Thursday Availability:

Friday: Friday Availability:

Saturday: Saturday Availability:

Sunday: Sunday Availability:

 

Education

Highest Level of Education Completed:

 

Name and Location of High School/GED:

Dates attended (From):

Dates attended (To):

Quarterly or Semester Hours:

Other (Specify):

Did You Graduate?:

Degree Earned:

Year Degree Earned:

 

Name and Location of Undergraduate School:

Dates attended (From):

Dates attended (To):

Quarterly or Semester Hours:

Other (Specify):

Did You Graduate?:

Degree Earned:

Year Degree Earned:

 

Name and Location of Postgraduate School:

Dates attended (From):

Dates attended (To):

Quarterly or Semester Hours:

Other (Specify):

Major or Subject:

Did You Graduate?:

Degree Earned:

Year Degree Earned:

 

Licences, Certificates, Registrations

Major or Subject:

Do You Have Any Occupational Licenses, Certificates, or Registration?:

License, Certificate, or Registration Name:

Number:

Where Issued:

Expiration Date:

License, Certificate, or Registration Name:

Number:

Where Issued:

Expiration Date:

 

Background

Have you ever been convicted of a crime (other than a moving violation) or served time? :

Describe Conviction:

 

Special Skills and Additional Certifications

Special Skills And Additional Certifications Held:

Languages Read, Written or Spoken Fluently Other Than English:

 

Work Experience

Employer (most recent):

Phone:

Employer Address:

Job Title:

Specific Job Duties:

Employment Dates (From):

Employment Dates (To):

Hours Per Week:

Number of Employees Supervised:

Last Salary:

Supervisor's Name:

 

Employer (next most-recent):

Phone:

Employer Address:

Job Title:

Specific Job Duties:

Employment Dates (From):

Employment Dates (To):

Hours Per Week:

Number of Employees Supervised:

Last Salary:

Supervisor's Name:

 

Employer (third most-recent):

Phone:

Employer Address:

Job Title:

Specific Job Duties:

Employment Dates (From):

Employment Dates (To):

Hours Per Week:

Number of Employees Supervised:

Last Salary:

Supervisor's Name:

 

 

References

Name of Reference #1:

Phone:

Email Address:

Address:

Relationship to You:

Years Known:

 

Name of Reference #2:

Phone:

Email Address:

Address:

Relationship to You:

Years Known:

 

Name of Reference #3:

Phone:

Email Address:

Address:

Relationship to You:

Years Known:

 

True Care Home Services Inc. is an Equal Employment Opportunity employer, and we do not discriminate in our hiring or employment practices. All qualified applicants will receive consideration without regard to race, color, creed, religion, national origin, age, disability, sex, or any other characteristic protected by State or Federal law.


APPLICANT’S CERTIFICATION AGREEMENT

1. I understand that I may submit a copy of my résumé or curriculum vitae (CV) and that by submitting a copy of my résumé/CV I understand that it will be used only as supporting and additional background information. A résumé/CV is not an authorized substitute for a completed employee application.
2. I understand that if I should choose to complete only a portion of the required employment application that the information submitted may not be enough information from which to base any determination on, and, as a result, my application may not receive full consideration for employment.
3. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information. I also release True Care Home Services Inc from all liability that may result from making background investigations.
4. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
5. I agree, if I am offered and accept a position, to conform to all existing and future workplace rules, regulations, policies, and procedures of True Care Home Services Inc.
6. I understand and agree that True Care Home Services Inc reserves the right to change any wage and hours of work, in its sole discretion, at any time as deemed necessary.
7. I understand the employment relationship will be At Will, meaning that either party can end the employment relationship at any time, and for any reason, or no reason with written notice.
8. I understand that I must submit to fingerprinting/background checks, drug testing, and/or medical testing as part of the process to determine my fitness for employment and hereby agree to submit to such testing. I authorize all persons, agencies, or other entities to release any information concerning my background or test results and hereby release from all liability any persons, agencies, or other entities supplying such information. I also release True Care Home Services Inc from all liability that may result from making such investigations. I understand that I must participate in fingerprinting/background checks, drug testing, and/or medical testing prior to being offered and accepting a position with True Care Home Services Inc.
9. I understand that any employment offer is contingent upon my providing proof of identity and eligibility to work within the United States to conform with the provisions of the Immigration Reform and Control Act of 1986.
10. I understand that all programs developed as part of my job responsibilities and all materials that I am entitled to receiving as part of my employment are the property of True Care Home Services Inc and that I will not try to copy, use, publish, or replicate a program or any materials for personal use, business ventures, or with other businesses. I understand that if this occurs legal action will ensue against me for violating this term of my employment.

I have read and reviewed the information contained in this employment application, as well as the above-mentioned statements of agreement. By signing this employment application, I certify that I understand all of the information requested and that I have provided information that is truthful, complete, and accurate.

 

 

Leave this empty:

Signature arrow

Signature Certificate
Document name: Application for Independent Contractors
lock iconUnique Document ID: 5a0cfd471cd0543b7b74d012ca04a3fdad90cefe
Timestamp Audit
January 1, 2021 12:08 pm ESTApplication for Independent Contractors Uploaded by Teresa Vigil - alexp@piperscleaning.com IP 104.228.22.28
January 4, 2021 5:43 pm ESTAlex Pelli - alexp@prospectgenius.com added by Teresa Vigil - truecarehomeservicesinc@gmail.com as a CC'd Recipient Ip: 104.228.22.28