Careers

    Personal Details

    Position Applied For

    Start date *: End date *:

    EDUCATIONAL BACKGROUND

    High School

    College

    Laboratory or X-Ray Training

    EMPLOYMENT HISTORY

    Provide the following from your past and current employer, assignments or volunteer activities – starting from the most recent (use additional sheets if necessary).

    REFERENCE(S):

    Give the name of three business/work references, not related to you, whom you have known at least one year. If not applicable, list three school or personal references that are not related to you.

    Reference 1

    Reference 2

    Reference 3

    PROFESSIONAL LICENSES, REGULATIONS AND/OR CERTIFICATION

    License / Certification 1

    License / Certification 2

    License / Certification 3

    EMERGENCY CONTACT:

    I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omission, or misrepresentation are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time.

    I give the employer the right to contact and obtain information from all references, employers, and educational institution and otherwise verify the accuracy of the information contained in this application.

    I consent to take the pre-employment physical examination and JMJ Home Health Services may require such future physical examination as at such times and places as JMJ Home Health Services shall designate. I understand that a photograph may be required after employment.

    I understand that I will be required to follow the personnel policies and rules of JMJ Home Health Services and that infraction of said rules might lead to dismissal. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on the application form.

    I further understand that JMJ Home Health Services follows the “fair employment practice code” and there is no discrimination in the firing of individuals based on sex, race, religion, age, color, disability, marital origin, ancestry, or physical or mental handicap unrelated to ability to perform the work required.

    I understand that if I am employed it will be on a probationary or trial basis for a period of 90 days. Upon termination, I authorize the release of reference on my work performance.

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