I understand the Immigration Reform Act of 1986 requires that, if hired, I must present on my first day of employment, but no later than
3 days from my first day of employment, documents to verify my legal right to work in the United States.
I hereby certify that all information provided here by me and on the attached resume is true and correct, and I understand that giving
false or misleading information may result in the refusal to hire me or in subsequent termination in my employment.
I understand if salaried, my salary commitment is based on a yearly salary schedule. I will comply with the policies and procedures of
I understand the number of hours I will be required to work may vary from week to week. I also understand that I may be required to work
different shifts as needed.
I authorize persons, companies, schools and colleges shown on my employment application to give any information regarding my employment
and academic records, together with any information they may have regarding me whether or not it is in their records. I hereby release
said companies, schools or persons from any liability for any damage whatsoever for issuing this information.
I understand that an offer of employment to work at Agapé Hospice is contingent upon the completion of a successful background check, a
clean drug screen, and other necessary screens as required.
By submitting application, I certify I have never been sanctioned by a government body related to healthcare, convicted of a criminal offense
related to healthcare, or listed by a federal agency as debarred, excluded, or otherwise ineligible for participation in a federal
funded healthcare program.
I understand, if hired, I will be required to hold Agapé Hospice’s confidential and / or proprietary information and any information concerning
patients of Agapé Hospice confidential and will not disclose it to any person or entity not affiliated with Agapé Hospice throughout
my employment and therafter.
I understand, if hired, my employment will be at-will and that my employment and compensation can be terminated with or without cause,
and with or without notice at any time, at the option of either Agapé Hospice or myself. By submitting this application I affirm my
awareness that this is the final understanding between myself and Agapé Hospice on the subject and there can be no modification or
agreement contrary to at-will provisions, unless in writing and signed by both parties.
I have read and accept the disclosure information