Employement Application

APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment with us, at High Roads Care Services. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form, are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drug use, may be required prior to employment.

AVAILABILITY

Due to the nature of the business, no guarantee can be made as to the schedule or the number of hours worked.

*For employment our minimum education requirement is either a GED or High School diploma

WORK HISTORY

Your application will not be considered unless all questions in this section are answered. Since we will contact previous employers, accurate phone numbers are required.

SECURITY

Please be sure to complete the attached Authorization to do a criminal and motor vehicle background check Please be sure to complete the attached Authorization

REFERENCES (Do not include relatives)

Please complete all six references. Your application will not be considered unless six references are provided. Since we will contact these references, please notify them in advance. If we are unable to reach all 6 references, you will be asked to provide additional references.

REFERENCE 2

CERTIFICATION AND RELEASE: I certify that I have read and understand the applicant note on page one (1) of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that this application is not a contract of employment. My employment is contingent upon confirmation of credentials and successful completion of drug test or criminal background check. I also understand that if hired, regardless of any oral presentations to the contrary, the employment relationship between HighRoads Care Services, and myself is terminable at-will, so that both the company and I remain free to choose to end our work relationship at any time for any or no reason. Any changes in this employment relationship must be made in writing. My signature below acknowledges that I have read, understand, and agree to the above disclosure. I also understand that due to the nature of the business, work hours are not guaranteed.

Thank you for your interest in joining our team at HighRoads Care Services. Please complete the following application form and provide accurate information. In addition to the standard application details, we require the following background checks and verifications:

1. State and National Background Checks:

The national background check must be completed through a Professional Background Screening Association (PBSA) accredited agency. Please visit the PBSA directory at https://thepbsa.org/directory/ to find an accredited agency for the national background check.

State background checks can be performed by our agency. Please provide the necessary information and consent for us to conduct the state background check.

Out-of-state checks are required for any individual who has lived in another state within the last 3 years. We will coordinate with the appropriate agencies to perform these checks.

2. National Sex Offender Registry Check:

A national sex offender registry check is mandatory and will be conducted at the time of hire. You can also choose to have this check performed through our PBSA accredited agency. (https://www.nsopw.gov/)

3. Pre-Hire State Sex Offender Registry Check:

Prior to hire, we will conduct a state sex offender registry check to ensure compliance with local regulations and maintain a safe working environment. Please provide your consent for this check. (https://sheriffalerts.com/cap_main.php?office=54567)

4. Pre-Hire and Routine Checks through DSS Administrative Actions List:

We will conduct pre-hire and routine checks through the DSS Administrative Actions List. This helps us verify your eligibility for employment. Please provide your consent for this check. (https://oig.hhs.gov/exclusions/index.asp)

Verification of Employee SSN through USCIS E-Verify Website:

We will verify your Social Security Number (SSN) using the USCIS E-Verify website to ensure eligibility for employment in compliance with federal regulations. Please provide your SSN for this verification. (https://idp.uscis.gov/)

By signing below, you acknowledge and authorize HighRoads Care Services to conduct the background checks and verifications as part of your application process. You understand that any false or misleading information provided may result in disqualification from employment consideration.