R&R Healthcare

R & R Health Care Services LLC is an equal opportunity employer. The agency does not discriminate in employment concerning race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status, or unfavorable discharge from military service or any other characteristic protected by law.

Disqualifying Offenses Attestation *

By checking below, you are attesting to having no previous convictions for the disqualifying offenses listed in OAC 5123:2-2-02 and attest you will notify R & R Health Care LLC within 14 days if ever charged with or plead guilty to a disqualifying offense as listed in OAC 5123:2-2-02.

I attest to the above statement

Personal Information

Incomplete information could disqualify you from further consideration. Please complete all fields.

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

State

Zip Code *

Email Address *

Home Phone

Mobile Phone *

Are you eligible to work in the U.S.? *

YesNo

Are you at least 18 years or older? *

YesNo

If no, you may be required to provide authorization to work.

Have you ever been terminated from employment or asked to resign by an employer? *

YesNo

If yes, please provide company names and details

Employment Desired

Date you can start *

Hourly rate/Salary desired *

Position desired *

Are you currently employed? *

YesNo

If so, may we inquire with your present employer?

YesNo

Can you perform the job's essential functions for which you are applying, with or without reasonable accommodation? *

YesNo

Education

List your educational background below. Leave blank if not applicable.

High School - Name and Location

High School - Degree Received

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

References

Give the names of three persons not related to you, whom you have known at least three (3) years.

Reference 1

Name *

Address, Phone, Email *

Company

Years Acquainted *

Reference 2

Name *

Address, Phone, Email *

Company

Years Acquainted *

Reference 3

Name *

Address, Phone, Email *

Company

Years Acquainted *

Emergency Contact

First Name *

Last Name *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Attestation and Signature

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for R & R Health Care LLC to hire me. If I am hired, I understand that either R & R Health Care LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of R & R Health Care LLC has the authority to make any assurance to the contrary.

I attest with my signature below that I have given R & R Health Care LLC accurate and complete information on this application. No requested information has been concealed. I authorize R & R Health Care LLC to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

I have read and agree to the above statement

Type Your Full Name as Signature *

Date *

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE.

Employment Application

Personal Information

Employment Desired

Referral Source

Education

Employment History

Most Recent Employer

Previous Employer

Previous Employer

Previous Employer

Special Skills

References

Reference 1

Reference 2

Reference 3

Emergency Contact

Availability

Attestation and Signature