* = Required Information
Applicant Authorization
PLEASE READ BEFORE SIGNING
Devoted Health Care, Inc. does not discriminate in hiring or employment on the basis of race, color, religion, age, disability, veteran status, or status within any group protected by federal, state, or local law. No questions on this application are intended to secure information to be used for any such discriminatory purpose.

This application will be given every consideration, but our receipt of it does not imply that you will be offered employment.

By signing your name below, you authorize investigation of all statements contained herein and the reference and employers listed to give you any and all information concerning your previous employment and any pertinent information they may have, personal or otherwise, and release Devoted Health Care, Inc. from any liability for any damage that may result from the utilization of such information.

By signing your name below, you certify that all statements made by you on this application are true and complete to the best of your knowledge and that you understand that misrepresentations or omissions may be cause for rejection, or may be cause for subsequent dismissal if you are hired or prosecution.

By signing your name below, you understand that nothing contained in the application or in the interview process is intended to create an employment contract between you (the applicant) and Devoted Health Care, Inc. Should this application result in your employment, you have a right to terminate your employment at any time and for any reason and Devoted Health Care, Inc. retain a similar right. You further understand that no representative of Devoted Health Care, Inc. other than {Nursing Supervisor/Administrative Staff} has any authority to enter into any agreement with you for any specified period of time or to guarantee some other personal move or benefit. You further understand this entire statement applies to the period prior to and after you may be employed.

I hereby acknowledge that I have read, understand, and agree to the above statements.

Application for Employment
Home Address
Incase of Emergency

Yes No
Yes No
Yes No
Full-time Part-time
Mon Tue Wed Thu
Fri Sat Sun Holidays
Yes No
Yes No
Yes No
Education Completed
High School or GED
College
HHA or NA Training School, or Any relevant training –correspondence or otherwise.

Former Employers
(Start with more recent employer; list last four employers)
1st Employer
2nd Employer
3rd Employer
4th Employer
Professional Knowledge/Experience (Nurses Only)
Category
Pediatric
IV Therapy
Psychiatric Nurse
Home Health Care
Geriatric Nurse
Podiatric
Community Health
Anesthesia
Other
Personal References

Please furnish three references with complete address. Do not list former employers or relatives. The individuals you list should have known you for at least one year

First Reference
Second Reference
Third Reference
Applicant Authorization (Please Read Carefully)
I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for dismissal or prosecution.

I authorize investigation of all statements contained herein and the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Devoted Health Care, Inc. from all liability for any damage that may result from utilization of such information.

By submitting this form you agree to the terms of the Privacy Policy.