Employment Application Full Name*
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Middle
Last
Address*
History Are you a citizen of the US? If no, are you authorized to work in the US? Have you ever worked at Arkridge before, If so, when? Have you been convicted of a misdemeanor? Have you been convicted of a felony? Any open investigations as this time? Do you have more than three driving violations on you MVR in the last 3 years? Did you graduate Diploma Work Availability Schedule Note, all positions are PRN and hours may vary. Every other weekend is required unless you want to work more.
Days of the week available:
Work History Do you have at least five years of work history?* If you do not have a five-year work history, please explain why?*
WORK HISTORY: Last five years required.
Previous Employer 1 Contact Person's Name*
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Previous Employer 2 Contact Person's Name*
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Previous Employer 3 Contact Person's Name*
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Previous Employer 4 Contact Person's Name*
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Previous Employer 5 Contact Person's Name*
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Personal References PERSONAL REFERENCES: Must list three; one must have known you at least five years (Do not list/duplicate work references, contacts or family members)
Name- Personal Reference 1*
First
Last
Name - Personal Reference 2*
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Last
Name - Personal Reference 3*
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Last
Authorization All of the above information is true to the best of my knowledge. I hereby authorize Arkridge homecare to request and receive any information and records including, but not limited to a criminal background check, driving, and previous/present employment, from any corporations, individuals, associations, agencies, or departments.
Typing your name and date into the field below serves as a digital signature and gives us permission to use the data collected in this form for background checks.
WHEREAS, Arkridge homecare LLC is engaged in the business of providing non-medical care and services to a variety of clients across the state of Tennessee. WHEREAS, the individual wishes to be an employee of Arkridge homecare LLC and agrees in whole to be bound by the terms set forth in this agreement as part of their employment privilege. WHEREAS, THEREFORE, in consideration of Arkridge homecare LLC entering into the employment agreement, the employment or continued employment of the employee by Arkridge homecare LLC and the continued receipt and access to confidential, proprietary, and trade secret information associated with the employee’s position at Arkridge homecare LLC, the employee and the employer agrees as follows:
Conditions of Employment: PLEASE READ AND INITITAL EACH POLICY1
I understand that this a PRN job. Hours may vary, and we are considered PART TIME. I understand that this a PRN job. Hours may vary, and we are considered PART TIME.
Upon employment with Arkridge homecare LLC. I understand that I will be working on an “as needed basis” and I am not guaranteed full time, specific amount of hours per week or permanent employment. Furthermore, assignments and employment are subject to change at any time. Shifts may be offered with little or no notice. Upon employment with Arkridge homecare LLC. I understand that I will be working on an “as needed basis” and I am not guaranteed full time, specific amount of hours per week or permanent employment. Furthermore, assignments and employment are subject to change at any time. Shifts may be offered with little or no notice.
I understand that employment will be subject to an initial 90-day probationary period in which I will undergo on job training assessment. I understand that employment will be subject to an initial 90-day probationary period in which I will undergo on job training assessment.
I understand that denying assignments within my stated availability times and areas can result in voluntary resignation of my position with Arkridge homecare LLC. It is my sole responsibility to update my availability of time and area with the office staff if it should change. Failure to do so, could result in voluntary resignation. Availability cannot change within the 90 days. Must give a weeks’ notice after the 90 days if it changes. I understand that denying assignments within my stated availability times and areas can result in voluntary resignation of my position with Arkridge homecare LLC. It is my sole responsibility to update my availability of time and area with the office staff if it should change. Failure to do so, could result in voluntary resignation. Availability cannot change within the 90 days. Must give a weeks’ notice after the 90 days if it changes.
I understand that excepting monies, gifts, or any other material items is strictly prohibited and will result in immediate termination from my position with Arkridge homecare LLC and could lead to a critical incident and a report to the state. I understand that excepting monies, gifts, or any other material items is strictly prohibited and will result in immediate termination from my position with Arkridge homecare LLC and could lead to a critical incident and a report to the state.
I understand that Arkridge homecare LLC strongly encourages participation in direct deposit and that if I forfeit this privilege, my paycheck will be mailed to me unless I request to pick up. Arkridge homecare LLC. WILL NOT issue a new check if one is lost in the mail until that paycheck is returned to the office or 30 calendar day’s lapse, whichever occurs first. I understand that Arkridge homecare LLC strongly encourages participation in direct deposit and that if I forfeit this privilege, my paycheck will be mailed to me unless I request to pick up. Arkridge homecare LLC. WILL NOT issue a new check if one is lost in the mail until that paycheck is returned to the office or 30 calendar day’s lapse, whichever occurs first.
I understand that maintaining a professional appearance including removing all piercings, covering tattoos and removing other jewelry is mandatory while on assignment with Arkridge homecare LLC. I understand that maintaining a professional appearance including removing all piercings, covering tattoos and removing other jewelry is mandatory while on assignment with Arkridge homecare LLC.
I understand that I am to wear scrubs at all times and close toe shoes. I am expected to always wear my scrubs while on assignment. I understand that I am to wear scrubs at all times and close toe shoes. I am expected to always wear my scrubs while on assignment.
I understand that I am to purchase my own latex free gloves and turn receipt in for reimbursement I understand that I am to purchase my own latex free gloves and turn receipt in for reimbursement
I understand that personal use of my cell phone or my client’s phone while on assignment is strictly prohibited unless an emergency, and will result in disciplinary action from Arkridge homecare LLC. I understand that personal use of my cell phone or my client’s phone while on assignment is strictly prohibited unless an emergency, and will result in disciplinary action from Arkridge homecare LLC.
I understand that discussing my compensation and or schedules with clients or co-workers is strictly prohibited and will result in disciplinary action from Arkridge homecare LLC. I understand that discussing my compensation and or schedules with clients or co-workers is strictly prohibited and will result in disciplinary action from Arkridge homecare LLC.
I understand that it is ultimately my responsibility to discuss any confusion in the policies, agreements or instructions with my manager and that failure to comply and abide by Arkridge homecare LLC’s policies could lead to disciplinary action up to and including termination. I understand that it is ultimately my responsibility to discuss any confusion in the policies, agreements or instructions with my manager and that failure to comply and abide by Arkridge homecare LLC’s policies could lead to disciplinary action up to and including termination.
Returning to work for Arkridge after 90 or more days of leave from company/schedules, employee will be subject to update application, background check, random drug testing. Returning to work for Arkridge after 90 or more days of leave from company/schedules, employee will be subject to update application, background check, random drug testing.
I understand that upon hire, it is required to clock in and out using 1of 3 methods required from TN Care, MCO’s and Arkridge. Methods are (Members Tablet, App on your phone, or Members phone). Failure to do so will result in disciplinary action, termination, and delay in getting paid. I understand that upon hire, it is required to clock in and out using 1of 3 methods required from TN Care, MCO’s and Arkridge. Methods are (Members Tablet, App on your phone, or Members phone). Failure to do so will result in disciplinary action, termination, and delay in getting paid.
I understand that upon hire, I have to turn my timesheets in on Monday by noon. Failure to do so, will result in disciplinary action, termination and delay in getting paid. I understand that upon hire, I have to turn my timesheets in on Monday by noon. Failure to do so, will result in disciplinary action, termination and delay in getting paid.
I understand that if employed with Arkridge that I will follow all CDC/Health Department guidelines and Arkridge polices regarding COVID-19. Failure to do so will result in termination. I understand that if employed with Arkridge that I will follow all CDC/Health Department guidelines and Arkridge polices regarding COVID-19. Failure to do so will result in termination.
My initials indicate that I have read all conditions and fully understand them. By signing below, I understand that if hired, I will be held accountable for following these conditions and policies and failure to do so, my employment would be terminated.
Authorization : I hereby authorize Arkridge homecare LLC and or its affiliates to investigate all statements and or facts contained herein as well as the references and employers listed to give Arkridge homecare LLC all and any information concerning my previous employment and any pertinent information they may have, personal or otherwise. Furthermore, I release the company from all liability for any damage that may result from utilization of such information. I personally certify that the facts contained herein and referenced above are true and complete to the best of my knowledge. I understand that falsification of the information contained herein and released to Arkridge homecare LLC, be it in verbal or written form, will be in automatic grounds for disqualification from employment and or will result in termination. Furthermore, I understand and agree that no representative of Arkridge homecare LLC and or its affiliates has the 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 authorizes company representative. This Waiver does not permit the release of or use of disability related or medical information in a manner prohibited by the Americans with Disabilities Act, ADA, and other relevant federal or state laws.
Background Investigation Requested
Background Investigation Compiled
(1) BACKGROUND INVESTIGATION QUESTIONNAIRE:
Name
Last
First
Middle Name
Address
Same as previous
Have you been convicted of any criminal offense, either misdemeanor or felony, other than minor traffic violations in the last 7 years? Are you currently charged or under investigation for any violation of the law other than minor traffic violations? 
