* = Required Information
AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL:



No Pref Mon Tue Wed Thur Fri Sat Sun Live In

FULL-TIME ONLY PART-TIME ONLY NO PREFERENCE

Yes No


Yes No


MILITARY


WORK HISTORY:

Please list your work experience for the past five years beginning with your most recent job held. If you were self employed, give the firm name. Attach additional sheets if necessary











EDUCATION:







REFERENCES:

Please list three business references that have knowledge of your work history.








Recommendation/Referral
Passing by Comfort Care’s Office
Career Center
Job Fair
Job Listings (Please specify: Newspaper, Internet, Other:)
Telephone Book
Social Networking Site (Please specify: Twitter, Facebook, MySpace, Other:}
Other (Please Specify:)

Applicants Authorization (please read carefully)

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for dismissal or prosecution. I authorize investigation of all statements contained herein and the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Comfort Care Home Health from all liabilities for any damage that may result from utilization of such information.

I understand that prior to employment that I must provide a valid driver’s license and consent to registry screening and submission of my fingerprints to the Oklahoma State Bureau of Investigation (OSBI) for forwarding to the Federal Bureau of Investigation (FBI) for the purpose of conducting a state and national criminal history records check.

  • Driver’s License (applicant must provide a copy)
  • Consent and Release Form – Registry and Criminal History Record Check (attached to application)


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