We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the applicant and/or interview process should notify a representative of the organization.

Please furnish the names, addresses and telephone numbers of two people to whom you are not related and by whom you have not been employed.

I certify that my answers are true and complete to the best of my knowledge. I authorize Healthy Hearts Home Health Care, LLC to make such investigations and inquiries of my personal, employment, educational and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.