Employment Forms

Employement - Custom


Please Enter 10 Digit Phone No.

General Information

In case of emergency notify?

Please Enter 10 Digit Telephone No.


License/Certification Infomation

License/Certification Infomation



Present Position

Previous Position

Previous Position

Attach Resume If Available

Education and Training





Telephone Reference Inquiries

ACKNOWLEDGEMENT & CONSENT (please read carefully and sign below)

I certify that the information in this application is accurate, current and complete. I understand that misstatements or omissions may result in disqualification from further consideration or termination of employment. I agree that, if hired, I may discharged if AAC earns of any falsification or material omission in the information I have provided and if discovered prior to hire, I would be ineligible for consideration if you have been convicted of a positions, as well. (NOTE: You will not automatically be excluded from consideration if you have been convicted of a crime. Your suitability for the position sought will be evaluated based upon the totality of circumstances such as the crime, the recency of the conviction, the type of work involved, etc.). I understand and agree that all information concerning patients and their families is strictly confidential. I am not permitted to disclose any financial, medical or personal information related to any patient or family member to fellow employees, company administrative staff or individuals, except my supervisor at All Angel Care. I authorize AAC to investigate my employment history, credentials, license verification and to obtain any relevant information, including a criminal background check needed to make an employment decision. I authorize AAC to disclose this application along state, federal, contractual or accreditation audit purposes. I also authorize AAC to disclose any of my performance appraisals, disciplinary records or skills tests for the same purposes as above. I release AAC and any information. I also understand and agree that passing a medical examination (which is my responsibility) and/or medical screening may be required. If medical restrictions cannot be reasonable accommodated, I may not be hired, or if hired, I may be terminated. I understand and agree that I may be subject to pre-employment drug testing and/or alcohol testing, random testing, as well as testing where reasonable suspicion or improper usage has occurred, or where warranted by an on-the-job injury, circumstance, workplace conditions or contractual requirements. I understand and agree nothing contained in this employment application or in granting of an interview creates an employment contract between AAC and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me. If an employment relationship is established, I understand that my employment will be "at-will;" that is, I will have the right to terminate my employment at any time and that AAC retains the same right to terminate my employment at any time. I understand that should I become employed by AAC retains the same right to terminate my employment at any time. I understand that should I become employed by AAC my work assignments, schedules and/or work locations are subject to change according to the needs of the business and the clients of AAC. I understand that AAC is committed to promoting safety and high standards of employee performance, productivity and reliability. In order to achieve this, I may be subjected to a drug test prior being hired to assure AAC do not currently have narcotics, sedatives, stimulants or other controlled substances and/or mood-altering substances in my body. I understand if I have any such substance in my body at the time of the drug test, AAC will not hire me. I understand that AAC reserves the right to add to, change and/or delete their policies, procedures, work rules and benefits at anytime and that no one in AAC has the authority to enter into an agreement for any particular period of time, or contrary to the above terms, unless that agreement is set forth in writing and signed by an authorized representative of AAC. I acknowledge, I have read and understand the contract terms and conditions stated above.