Application Form

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.
We Do Background Check and Drug Test For Employment.

Personal Information

Section 1 - General Information

Section 2 - Educational Background

Section 3 - 1st Most Recent Employer

Section 4 - 2nd Most Recent Employer

Section 5 - Reference 1

Section 6 - Reference 2

Section 7 - Emergency Contact Person:

Section 8 - Agree/Consent/Signature

(Numeric Answer Only)

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
If employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its director and designated person, the employment relationship will be “at-will”.  In other words, the relationship will be entirely voluntary in nature, and either I or the employer will be able to terminate the employment relationship at any time and without cause.  I understand that I will be an employee of the company and not of any client.  I further understand that my employment is not guaranteed for any specific time and may be terminated at any time for any reason.
BACKGROUND CHECK AUTHORIZATION
The information contained in this application is correct to the best of my knowledge. I hereby authorize Comfort Keepers and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Comfort Keepers or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I hereby release Comfort Keepers the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release. 
DRUG and ALCOHOL Test Consent 
It is our Policy to not continue employment of anyone who test positive for any illegal substance and/or drugs in their system regardless to the frequency or amount that they may have used. Medication legally prescribed are excluded.  All employees may be required, as permitted by federal and state laws, to undergo a drug test for pre-employment purposes, random testing or for cause which is due to reasonable suspicion of Comfort Keepers.  Employees may also be required to undergo alcohol screening when there is a suspicion of on-the-job impairment.  The test will be administered at a location of Company's choosing.  The company is responsible for the expense of the test, except that the employee agrees to pay for the test that is POSITIVE for any illegal substance and/or drugs. I further agree that it may be deducted from my paycheck.  I understand that I may be required to submit a urine sample for chemical analysis and that this analysis will be performed by qualified personnel.  I freely consent and volunteer to this request for a specimen of urine.  I hereby release Comfort Keepers, CK Franchising, INC., the medical provider, laboratory performing the analysis including their employees and/or agents, from any liability whatsoever arising from the request to furnish my urine specimen, the testing of the specimen and the decisions made concerning my employment based upon the results of the analysis.  I understand that anyone who refuses to take or who fails to pass a drug screening test will not be qualified for employment by Comfort Keepers.  I have read the policy, understand it, and agree to the testing as part of the terms and conditions of my employment.