• High School

  • Undergraduate College

  • Graduate Professional

  • Other

  • Please list your work experience beginning with your most recent job held. Please include at least the past five years.

      • Dates Employed
      • Salary
      • Status
  • (If hired, verification will be required upon employment)
  • Please provide any other information that you feel will help usin considering your application for employment:

  • If you have a resume you would like to send, please attach it.

    • I have read and fully understand the questions asked in this application. I certify that all answers given by me are true, accurate, and complete. I hereby authorize Alick's Home Medical, Inc to obtain employment and educational references for me from all current and prior employers and educational institutions and release all persons from liability for providing such reference information. I hereby release Alick's Home Medical Inc from any/all liability of whatever kind and nature, which at any time, could result from obtaining and basing an employment decision on such information. I understand that, if employed, Alick's Home Medical Inc may terminate my employment if I have made any false statements or misrepresentations in this application or during the interview process.

      I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of Alick's Home Medical Inc. However, I further understand that neither the policies, rules, or regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either Alick's Home Medical Inc or I may terminate my employment at any time with or without notice or cause. I understand that Alick's Home Medical and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance, or otherwise change all policies, procedures, benefits, or other terms or conditions of employment

      My signature below indicates that I have read, understand, and agree to the above statements.

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