As the applicant, I hereby authorize Excellent Home Health Care may request and receive, within one year of the date of my signing this application, any and all pertinent information concerning my prior employment and its termination, including reasons for such termination from all prior employers. I understand that all references listed above may be contacted in addition to past employers and educational institutions. I give permission for Excellent Home Health Care to contact my current employer for a reference.

I certify that answers given are true.  I give the agency authorization to complete an investigation of my statements and for a criminal background check to be completed.  False or misleading information may result in my discharge.  I understand I am required to abide by the rules and regulations of the agency.

I further understand that if I am hired, I can be terminated, with or without cause and with or without notice. I agree to have my picture taken for identification purposes and to submit to drug screening tests, upon request, with or without cause.

I understand that if I am applying for a DSP Position, I give the agency authorization to send me for fingerprinting (separate background check for the DHS), to conduct a central registry check, drug screening, and CARI check, to meet DHS standards.

I also understand that the agency is an Equal Opportunity Employer, and all applicants are considered for all positions without regard to race, color, religion, sex, national origin, age or marital status.