Online Application

Education

High School: City:

State:

Graduated Yes or No: Year: Diploma or GED:

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College: City:

State:

Area of Study: Year Graduated:

Certificate / Diploma:

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College: City:

State:

Area of Study: Year Graduated:

Certificate / Diploma:

Additional Training / Education or other pertinent skills and qualifications:

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Employment (List in order, starting with present employer or most recent. Please explain any gaps.)

Dates Employed: to

Company: Telephone:

Address:

Principal Duties:

Reason for Leaving:

Starting Pay: Ending Pay:

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Dates Employed: to

Company: Telephone:

Address:

Principal Duties:

Reason for Leaving:

Starting Pay: Ending Pay:

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Dates Employed: to

Company: Telephone:

Address:

Principal Duties:

Reason for Leaving:

Starting Pay: Ending Pay:

I certify that the information contained in this application for employment is true and correct, without any omissions or misleading statements. I authorize Dobson Healthcare Services, Inc. to investigate and verify all information contained in this application. I understand and agree that Dobson Healthcare Services, Inc. may reject my application for false statements, misleading statements, or omissions made in connection with my application. I agree that if I am employed; false statements, misleading statements, or omissions shall be considered cause for dismissal and that Dobson Healthcare Services, Inc. shall not be held liable for terminating my employment.

Employee Notice: I, the undersigned perspective employee, acknowledge that by my electronic signature, either Dobson Healthcare Services, Inc. or I can terminate an employment relationship at any time, as employees are At-Will. I also acknowledge that if employed and Dobson Healthcare Services, Inc. does not receive payment from the client for services which I perform as an employee, Dobson Healthcare Services, Inc. will pay me the applicable minimum wage (or the legally required, overtime pay in a work week in which overtime was worked) for any such pay period, and I agree to this method of compensation. I understand and agree that no representative of Dobson Healthcare Services, Inc. has any authority to enter into any agreement for my employment, or for any specified period of time, unless it is in writing and signed by Dobson's Chief Executive Officer. In all instances, I understand and agree if employed with Dobson Healthcare Services, Inc., I will be employed as an At-Will employee despite any other relationship with Dobson Healthcare Services, Inc.

Pre-Employment Drug Testing Policy: All job applicants, as a condition for employment, shall voluntarily submit to screening for the presence of illegal drugs. Any applicant with positive test results shall be denied employment at that time.

The company will not discriminate against applicants for employment because of past abuse of drugs or alcohol. It is the current abuse of drugs or alcohol, which prevents employees from properly performing their jobs that the company will not tolerate.”

Equal Opportunity and Harassment: I also agree that if at any time while employed I am subjected to any type of discrimination, including discrimination because of race, sex, religion, color, veteran status, retaliation, national origin, handicap, disability or marital status, or if I am subjected to any type of harassment including sexual harassment, I will immediately contact Dobson Healthcare Services, Inc. Human Resources Department at 1-866-866-8908 in order to obtain assistance in the resolution of such matters.

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Online Application TO APPLICANT: Dobson Healthcare Services, Inc. is an equal opportunity employer. Your application will be judged on your qualifications for the positions available. We do not discriminate on the basis of race, color, religion, disability, handicap, marital status, veteran status, national origin, sex, or age. The questions on this application will help us evaluate your qualifications. Proof of your identity and eligibility for employment, in accordance with the requirements of law, will be required. Dobson Healthcare Services, Inc. is a Drug-Free Workplace. All employees may be subject to random drug testing.
First Name: Middle Name: Last Name: Appendage: Email: Title: Address 1: Address 2: City: State: Zip/Postal Code: Country: -------------------------------------------------------------------------------------- Education High School: City: State: Graduated Yes or No: Year: Diploma or GED: -------------------------------------------------------------------------------------- College: City: State: Area of Study: Year Graduated: Certificate / Diploma: -------------------------------------------------------------------------------------- College: City: State: Area of Study: Year Graduated: Certificate / Diploma: Additional Training / Education or other pertinent skills and qualifications: -------------------------------------------------------------------------------------- Employment (List in order, starting with present employer or most recent. Please explain any gaps.) Dates Employed: to Company: Telephone: Address: Principal Duties: Reason for Leaving: Starting Pay: Ending Pay: -------------------------------------------------------------------------------------- Dates Employed: to Company: Telephone: Address: Principal Duties: Reason for Leaving: Starting Pay: Ending Pay: -------------------------------------------------------------------------------------- Dates Employed: to Company: Telephone: Address: Principal Duties: Reason for Leaving: Starting Pay: Ending Pay: I certify that the information contained in this application for employment is true and correct, without any omissions or misleading statements. I authorize Dobson Healthcare Services, Inc. to investigate and verify all information contained in this application. I understand and agree that Dobson Healthcare Services, Inc. may reject my application for false statements, misleading statements, or omissions made in connection with my application. I agree that if I am employed; false statements, misleading statements, or omissions shall be considered cause for dismissal and that Dobson Healthcare Services, Inc. shall not be held liable for terminating my employment. Employee Notice: I, the undersigned perspective employee, acknowledge that by my electronic signature, either Dobson Healthcare Services, Inc. or I can terminate an employment relationship at any time, as employees are At-Will. I also acknowledge that if employed and Dobson Healthcare Services, Inc. does not receive payment from the client for services which I perform as an employee, Dobson Healthcare Services, Inc. will pay me the applicable minimum wage (or the legally required, overtime pay in a work week in which overtime was worked) for any such pay period, and I agree to this method of compensation. I understand and agree that no representative of Dobson Healthcare Services, Inc. has any authority to enter into any agreement for my employment, or for any specified period of time, unless it is in writing and signed by Dobson's Chief Executive Officer. In all instances, I understand and agree if employed with Dobson Healthcare Services, Inc., I will be employed as an At-Will employee despite any other relationship with Dobson Healthcare Services, Inc. Pre-Employment Drug Testing Policy: All job applicants, as a condition for employment, shall voluntarily submit to screening for the presence of illegal drugs. Any applicant with positive test results shall be denied employment at that time. The company will not discriminate against applicants for employment because of past abuse of drugs or alcohol. It is the current abuse of drugs or alcohol, which prevents employees from properly performing their jobs that the company will not tolerate.” Equal Opportunity and Harassment: I also agree that if at any time while employed I am subjected to any type of discrimination, including discrimination because of race, sex, religion, color, veteran status, retaliation, national origin, handicap, disability or marital status, or if I am subjected to any type of harassment including sexual harassment, I will immediately contact Dobson Healthcare Services, Inc. Human Resources Department at 1-866-866-8908 in order to obtain assistance in the resolution of such matters.	Date Avail: Phone: Cell Phone: Alt. Phone: 18 or Older Yes or No: Referred By: Emergency Contact: Position Desired: Range of Pay: Currently Employed Yes or No: Contact Current Employer Yes or No: License or Cert #: Expiration of Above: Have you ever been convicted, pled guilty or no contest to a crime; felony or misdemeanor Yes or No: Have you ever been convicted or investigated in the abuse of an adult or a child? Yes or No: If so, state the nature of the offense and the date the offense took place: (A conviction does not necessarily disqualify you from employment)

“Celebrating 20 Years of Caring”