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Type of Employment Desired
Do you have experience with Brightree or Apacheta?
Do you have experience in DME or home health?
Have you ever worked for this company?
Are you legally allowed to work in the United States?
Have you ever pleaded guilty, no contest or been convicted of a crime?

Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Education History
Did you graduate?
Did you graduate?
Do you speak Spanish?
Previous Employment (begin with the most recent position)
May we contact this employer for a reference?
May we contact this employer for a reference?

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

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