If answered NO to the previous question, describe the functions that cannot be performed:
We comply with the ADA/FEHA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.
Has your professional license (if required for a position) ever been revoked?
Have you graduated from High School or do you possess a GED?
List any training, certificates, licenses, computer, or language skills which directly relate to position applied for:
List your employment for the past 7 years, beginning with your current or most recent employer and work backwards. List each change of title or promotion separately. Account for periods of unemployment and indicate any other experience, which you feel, is relevant to the position for which you are applying. Attach an additional sheet if extra space is needed. If you have prepared a resume which contains all the information requested below, please attach to the application.
here to add additional work history Click
Please read carefully and confirm below:
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
This application form is not an employment contract. The information provided within this application is used in evaluating applicant’s qualifications for employment. At Staff Assistance Inc., Assisted Home Recovery, Inc. and/or Assisted Home Care, Inc. our continued success depends on the full and effective recruitment and employment of qualified persons regardless of race, color, religion, sex, age, national origin, marital status, disability, veteran status or any other protected status as prescribed by law. We are committed to ensuring equal employment opportunity for all employees and applicants for employment. It is our goal to recruit, hire and develop the best employees using only job-related qualifications.
I confirm and acknowledge that above statements are true and I agree to the for-mentioned conditions:
Submit Resume: (file types accepted: .doc & .pdf)
Please note that some Microsoft Word formats, such as .docx files, will not work to upload.
Click here to learn how to save a .docx file as a different format.