APPLICANT’S STATEMENT I certify that the answers given within this application are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 90 days. I understand that any applicant wishing to be considered for employment beyond this time should inquire after the 90 day period to determine whether or not applications are being accepted at that time. I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. BACKGROUND CHECKS All applicants are required to submit a criminal background check prior to employment. If hired, you will be offered employment on the basis of the information found within that report. At a later time, Advantage Care will do a complete state background check of our own that we do on all employees. If this report should come back with any incriminating evidence, you may not be eligible for continued employment with Advantage Care. By signing below, you confirm that you understand Advantage Care’s policy related to background checks. INDEPENDENT CONTRACTOR DISCLOSURE I understand that if I am hired through Advantage Care, I will be considered an Independent Contractor. As an Independent Contractor, I will be responsible for paying my own taxes. I also understand that Advantage Care is relieved of all financial responsibility for the payment of my personal taxes. I further recognize that at the close of each tax year, I will receive a 1099 Miscellaneous Non-Employee Income Statement, which should be used to compute my personal income taxes, independent of my employer, Advantage Care. WORKING WITH FAMILY Medicaid regulations will not allow direct care providers to service immediate family. Therefore, Advantage Care does not employ family members to work with their immediate family members. The following are considered immediate family: mother, father, brother, sister, grandparents, grandchildren, children and spouse. This includes “step” and “in-law” relationships. As a potential employee of Advantage Care, I hereby acknowledge that I am aware of the above regulation and policy. I confirm that I will not be working as a service provider with my immediate family. I further confirm that I will not knowingly accept assignments with immediate family. This does not apply to clients in the CAP program. I also understand that I will be terminated from my employment with Advantage Care if it is found that I have knowingly misled the agency by disregarding this regulation.
