Please give us the NAMES, and BUSINESS TELEPHONE NUMBERS of people who are familiar with your WORK EXPERIENCE and TECHNICAL COMPETENCE in the job for which you are applying, preferably technical associates with whom you have worked and give Vital Sign Home Care permission to contact. (DO NOT LIST PERSONAL REFERENCES.)
Most Recent Employer
Second Most Recent Employer
Third Most Recent Employer
Please fill in calendar years of experience:
I hereby give Vital Sign Home Care the right to make a thorough investigation of my past employment, education and activities and release from all liability whatsoever al persons, companies, and corporations supplying such information. I expressly agree to indemnify Vital Sign Home Care against any liability, which might result from making such investigation. I understand that any false answers, statements or implications made by me in this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Vital Sign Home Care, and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon Vital Sign Home Care unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time for any reasons, and that Vital Sign Home Care retains a similar right. I have no objection to making application for security clearance, if necessary, signing an employee agreement on confidential information and inventions, or taking a medical examination. I also agree to provide, if necessary, the results of a physical examination completed no more than six months ago, at no cost to Vital Sign Home Care I also authorize Vital Sign Home Care to release such medical information as may be necessary to their clients for obtaining approval of my assignment to a client's facility. (Home) I understand and agree that I may be required to take a skills assessment examination. My signature below is an acknowledgement that I have fully read, understand and agree with all terms and conditions of this application.
By filling in your name below, this serves as your electronic signature.