Application for Employment First Name Middle Name Last Name Date of Birth Date Available to Start Applicant Phone Number Email Address Applicant Full Home Address Shift Availability Day shift Evening Night 12 hour Day 12 hour Night Any Shift Desired Employment Type Full-time Part-time On-call Any Who Referred You? Location Interest Maple Grove Spring Lake Park/Fridley St Michael Bloomington Brooklyn Park office St. Cloud Office Community-Based Care Any Location Other How did you hear about us? Google search Direct Mail Marketing Family Member Social Media Current Patient Other Position you are applying for Other Names You Have Used in the Past Qualifications PA NP CNA LPN RN CPR First Aid Enter your Certificate Number(if any) Education History Did you graduate from High School? YES NO Are you legally authorized to work in the United States? Yes No Have you ever been disqualified from working in a position providing direct contact services to vulnerable adults or minors in Minnesota or any other state? Yes No Relevant Skills Employment History (List 3 recent if possible) Are you at least 18 years old? Yes No I consent to a background check and DHS/MDH disqualification study as required for healthcare positions in Minnesota. Yes No I certify that all information provided in this application is true and accurate to the best of my knowledge Yes No 1 on 1 Comprehensive Healthcare Solution LLC is an Equal Opportunity Employer. We consider all qualified applicants without regard to race, color, creed, religion, national origin, sex, marital status, familial status, disability, public assistance status, age, sexual orientation, gender identity or expression, military or veteran status, or any other protected characteristic under applicable law. We are committed to creating an inclusive workplace where all individuals feel respected, valued, and supported. Check here if you agree to this. At-Will Employment If hired, I understand that my employment with 1 on 1 Comprehensive Healthcare Solution LLC will be on an “at-will” basis, meaning either I or the company may terminate the employment relationship at any time, with or without cause or notice, unless otherwise prohibited by law. Nothing in this application, the hiring process, or any company document creates a contract of employment for any specific duration. Check here if you agree to this. Background Study Authorization I understand that, if offered employment, I will be required to complete a Minnesota Department of Human Services (DHS) and/or Minnesota Department of Health (MDH) background study in accordance with state law and applicable licensing requirements. This background study will include verification of my identity and may involve checks of criminal records, maltreatment of vulnerable adults/children records, and other registries as required by law. I authorize 1 on 1 Comprehensive Healthcare Solution LLC and its authorized agents to initiate and process this background study, and to receive and use the results for employment eligibility determination as required by law. Check here if you agree to this. Privacy & Use of Information The information provided in this application will be used to evaluate your qualifications for employment and, if applicable, to complete any required pre-employment checks such as background studies or reference verifications. This information may be shared with authorized third parties only as necessary to fulfill these purposes or as required by law. We safeguard your information in compliance with applicable privacy regulations. For details, please see our Privacy Policy. Check here if you agree to this. Reference & Employment Verification Authorization I authorize 1 on 1 Comprehensive Healthcare Solution LLC to contact my current and/or former employers, educational institutions, licensing boards, and professional references to verify the information provided in this application and to obtain job-related information about my background, qualifications, and work history. I release all persons and organizations from any legal liability arising from providing such information. Check here if you agree to this. Applicant Certification: I certify that the information provided in this application is true, complete, and correct to the best of my knowledge. I understand that any false or misleading statements, omissions, or misrepresentations, whether on this application or in any interview, may result in rejection of my application or, if employed, termination of employment. I understand that this application is not an employment contract and that, if hired, I will be employed on an at-will basis unless otherwise prohibited by law. I have read, understood, and agree to all statements above, including Equal Employment Opportunity, At-Will Employment, Background Study Authorization, Privacy & Use of Information, Reference Authorization, and Applicant Certification. Enter your full Name below to sign this application Signature Date SUBMIT Learn more about career opportunities at 1 on 1 Comprehensive Healthcare – click below To learn more about RN Position Click here To learn more about Home Health Aide/PCA/DSP Position Click here To learn more about Home Health Aide/PCA/DSP Position Click here
