If no, provide addresses for the last 5 years.

List the days and hours you are available to work

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Applicant's Education and Training

Applicant Employment History

List your current or most recent employment first.

References

List any three work related people (non- relatives) who would be willing to provide a reference for you.

CERTIFICATION

I certify that the information provided on this application is true and accurate to the best of my knowledge. I understand that providing false or misleading information can be a basis for rejection of my application, or if employment commences, immediate termination.

I authorize Helpful Hearted Providers, LLC to contact former employers, references and educational organizations regarding my employment and education. I authorize my former employers, references, and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its CEO, the employment relationship will be "atwill." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the same rights. Moreover, no agent, representative, or employee of Helpful Hearted Providers, LLC, except in a specific written contract of employment signed on behalf of the organization by its CEO, has the power to alter or vary the voluntary nature of the employment relationship.