Call Us Today
Application Form

Personal




Full TimePart TimeOn Call



MondayTuesdayWednesdayThursdayFridaySaturdaySunday


YesNo

Licenses


Add another license



Add another license


Certification

CertifiedRegisteredRegistry EligibleOther



YesNo


YesNo


YesNo


YesNo


YesNo


YesNo


YesNo

Educational History

High School

College

Graduate School

Other

Employment History


YesNo


YesNo

Please provide the information below starting from most recent.

Add another position


Add another position


Add another position


Add another position


Please list four (4) professional references





Employee agreement

● I certify the information stated on my application for employment is true and complete. I understand that any false statement or omission on the application or attachments may result in refusal of employment or immediate termination from AdvisaCare.
● I understand that this employment application and any other company documents are not contracts of employment, express or implied, and that if hired, any employment with AdvisaCare is considered to be "at will" employment and may be terminated for any reason or cause: with or without notice.
● I understand that I may express preference for certain hours, days, or facilities for employment assignment, but these preferences may limit AdvisaCare's ability to offer assignments. I also understand that I may accept or decline assignments offered, and that, in any event, AdvisaCare does not guarantee me any fixed number of hours of work in any given time period.
● I authorize the release of all records pertaining to my education, work history and medical history to AdvisaCare.
● I authorize the release of background information obtained through a criminal record check to AdvisaCare as a voluntary pre-employment screening to assure the safety and security of their clients and employees.
● I consent to drug and/or alcohol testing at the discretion of AdvisaCare
● I authorize AdvisaCare to seek and obtain any and all information concerning my previous work and employment history from all my previous employers.
● I agree to maintain confidentiality regarding the affairs of AdvisaCare and its clients, including general business, names, addresses, and phone numbers of field staff and clients, anticipated changes in staff or management, or company pricing. I agree to maintain confidentiality regarding the identity, personal affairs, or medical status of facility patients or about the services provided to them.
● I understand I am prohibited from becoming employed by, or receiving compensation from, any client of AdvisaCare if I was assigned to provide services there by AdvisaCare within six (6) months of accepting the offer of employment or compensation. I further understand that failure to abide by this policy will result in my responsibility for payment of a fee to AdvisaCare or liquidation damages. This fee will be $8,500 if I am a Nurse or Therapist, and $5,000 if I am an Aide or Medical Assistant.
● I understand I must complete required OSHA training on Blood Borne Pathogens and the procedure to follow if I experience an occupational exposure, including the method of reporting the incident and the medical follow-up that will be made available prior to starting clinical shifts.


By signing below, I acknowledge that I have read and agreed to the above-mentioned items.