Employment Application

Job Application

Applicant Information

Address
Can you receive Text Messages?
Are you 18 years of age or older?
Are you legally entitled to work in the U.S.?
Have you ever worked for this company?
Have you ever been convicted of a felony?

Education

Did you graduate?
Did you obtain a GED?
Did you graduate?
Did you graduate?

References

Please list three professional references Do not include family, friends or acquaintances.

Address
Address
Address

Previous Employment

Address
May we contact your previous supervisor for a reference?
Address
May we contact your previous supervisor for a reference?
Address
May we contact your previous supervisor for a reference?

Military Service


Background Check

Kaiser Home Support Services, Inc. requires a comprehensive background check, which consists of prior employment verification, professional reference checks, education verification, and a State Nurse Aide registry check. In addition, criminal background and sex offender registry checks are required for each county and state where the applicant has lived in the past three years.

Any applicant who has been convicted of a felony drug charge, theft, exploitation, murder, voluntary manslaughter, felony battery, controlled substance offense, or violent sex crime or battery against a dependent population will not be eligible for hire.

I understand that I must submit the necessary information required to conduct a comprehensive background check and will not be placed with a client until these requirements are satisfactorily met. I further understand that I may be required to obtain an original copy of the county criminal background check results, the cost of which will be reimbursed.


Tuberculosis (TB) Skin Test

I understand that Kaiser Home Support Services, Inc. requires a current, negative Tuberculosis (TB) Skin Test to be completed prior to working with clients. I further understand that Kaiser Home Support Services, Inc. requires a current, negative TB Skin Test each year for continued employment, and I may not be eligible to work until this requirement has been satisfied.


Drug Testing

Kaiser Home Support Services, Inc. is required by Executive Order No. 90-5, April 12, 1990 to have a Drug-Free Workplace Certification. For this reason, Kaiser Home Support Services, Inc. has a zero tolerance Drug- and Alcohol-Free Workplace Policy Policy and requires the following Drug and/or Alcohol Testing:

- Pre-employment Testing
- Post-injury Testing
- Follow-up Testing
- Random Testing
- Reasonable Suspicion Testing

I understand that Kaiser Home Support Services, Inc. prohibits the use, possession, distribution, or sale of drugs or alcohol, or being under the influence of drugs or alcohol while in the workplace, during work hours, or on company premises or company time. I further understand that I will be subject to Drug Testing as described above, and any violation of Kaiser Home Support Services, Inc. Drug- and Alcohol-Free Workplace Policy will result in (a) ineligibility for employment or (b) termination of employment.


Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release

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