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Personal Information
Position(s) Applied For*
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Last Name*
First Name*
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Address*
City*
State*
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Zip Code*
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Education
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School Name
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# years completed
Did you graduate?
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Degree Earned?
Diploma
GED
Undergraduate College
School Name
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# years completed
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Degree Earned?
Major
Graduate Professional
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# years completed
Did you graduate?
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Degree Earned?
Major
Other
School Name
City/State
# years completed
Did you graduate?
Yes
No
Degree Earned?
Major
Employment History
Specialized Training & Activities
Describe any specialized training, apprenticeshps, licenses, or skills that you feel may be relevant to the job you are seeking:
Activities (Civic, Athletic, etc.):
General Information
What salary rate of pay do you expect to receive if employed?
On what date would you be available to work?
REFERENCES
Name
Phone Number
Relationship/Occupation
Years Known
Name
Phone Number
Relationship/Occupation
Years Known
Name
Phone Number
Relationship/Occupation
Years Known
Upload Resume
Upload your Rèsumè:*
APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION:-IMPORTANT: Read before signing.
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.
Signature of Applicant*
Date
