Application Extended - Elite Care Management

Are you a U.S. citizen or authorized to work in the U.S.?

Yes No

Have you ever been employed under another name?

Yes No

Have you ever applied to this company before?

Yes No

Have you been convicted of a crime within the last 7 years?

Yes No

High School Attended

Degree or Subjuct Studied

Are you currently employed?

Yes No

May we contact your current employer?

Yes No

Are you fluent in any other language?

Yes No

References (please provide name address and contact information for 3 persons not related to you who can provide information relative to your ability to work

Previous Job Experience

Employment Availability

Position You Are Interested In

Time Availability

Checking this box I understand and agree to all the statements and conditions listed below below

I certify that all the foregoing statements are true to correct to the best of my ability. I understand that misrepresentations and omissions of facts is cause for denial of employment or dismissal.

I understand that inquiries will be made of former employers and references regarding work performance and of educational institutions regarding transcripts. I release from all liability all persons, companies and corporations, and educational institutions supplying such information. Additionally, I will indemnify and hold harmless the company and its officers, directors, employees, and agents against any liability, which might result from making such an investigation.

I understand that if employed at Elite Care Management, my employment is at will and that I or the company can terminate the employment relationship, with or without cause, at any time, with or without prior notice.

Please fill Out Application Form Below