Equal Opportunity Employer
New England Home Health Care is an Equal Opportunity Employer and does not discriminate in hiring or employment on the basis of race, color, religion, sex, disability, age, national origin, ancestry, or any other classification protected by law.
(New England Home Health Care conducts criminal record checks. Failure to divulge complete information will disqualify you from employment. Conviction of a crime does not disqualify the applicant from employment consideration.)
Record of Employment
Beginning with your present or last position, list the last four jobs you have held, including a summary of experience, etc. (indicate military experience if job related). If you have a résumé, please attach to application.
Previous Employer #1
Previous Employer #2
Summarize prior relevant experience and fill in periods of unemployment or periods not accounted for above.
I hereby certify that the above information is correct and complete to the best of my belief. I make this statement with knowledge that any false or misleading statement or omission of material fact may result in dismissal. I understand any job offer by New England Home Health Care is conditioned upon: (1) Receipt of acceptable recommendations for reference; (2) Proof of U.S. Citizenship or appropriate visa or work permit; (3) Successful completion of a pre-placement physical examination, including substance abuse testing; (4) Review and approval of background checks including criminal history, driving record, state licensing/certification verification. I authorize an investigation, through whatever means deemed appropriate, of all statements contained in this application and all facts resulting from the investigation. I release from all liability all sources supplying such information. The employer is authorized to use any information obtained from its investigations to determine my suitability for employment. I release New England Home Health Care from any liability in connection with such investigation.
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