Hands That Heals LLC - Employment Application

Last Name *

First Name *

Email Address *

Phone Number

Address

Date of Birth

SSN (XXX-XX-XXXX)

Position Applying For *

Include paid and unpaid positions.

Emergency Contact

Name

Relationship

Address

Phone

Alternate Phone

Professional References

Name

Tel No

Address

Name

Tel No

Address

Background Check Authorization: I authorize Hands That Heals LLC. to perform a criminal background check. *

Employment Agreement: I agree to at-will employment terms. *

Confidentiality Agreement: I will not disclose client or company information. *

Non-Solicitation Agreement: I will not solicit clients or employees after termination.

Non-Driving Agreement: I do not have a valid license and will not transport clients.

COVID-19 Fit for Work: I am symptom-free and will follow PPE guidelines. *

Hepatitis B Vaccination Declined: I decline the free vaccine after being informed of risks.

Influenza Vaccine Declined: I decline the flu shot.

Sexual Abuse Policy: I acknowledge receipt and understanding.

Confidentiality Statement: I agree not to disclose PHI.

Employee Handbook: I received and read it.

Non-Solicitation Agreement: I understand its terms.

State of Illinois Acknowledgement: I understand CCP rules.

Upload Supporting Documents

Resume/CV

ID Card (Front & Back)

CPR Certification