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Name
Address
Position Applied For:
Are you applying to work with a specific person/family?
Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
Do you have any specialized certifications? (ex: CNA, LPN, etc.)

EDUCATION

Did you graduate High School?
Did you graduate?

REFERENCES

Please list three references of persons not related to you, whom you have known for more than three years.

Reference 1

Reference 2

Reference 3

PREVIOUS EMPLOYMENT

Employer 1

May we contact your previous supervisor for a reference?

Employer 2

May we contact your previous supervisor for a reference?

Employer 3

May we contact your previous supervisor for a reference?

Military Service

Please use this additional space to describe in detail any experience you have this is related to the position applied for (personal, professional, or educational) that is not already noted on this application.

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. By signing/typing my name below, I authorize Forte Residential/Forte Home Health Care to complete Employment Verification checks as authorized above. This information may be shared with any company or family representative involved with my potential employment. I understand that providing false or misleading information or omissions of information in my application or interview may result in my being ineligible for hire with this Agency.

FOR OFFICE USE ONLY

NOTICE REGARDING BACKGROUND INVESTIGATION

A consumer report (background screening report) and/or an investigative consumer report which may include information obtained through personal interviews concerning your character, employment history, general reputation, personal characteristics, police record, education, qualifications, motor vehicle record, and mode of living, may be obtained in connection with your application for and/or continued employment, contract for services or volunteer services with Forte Residential, Inc. and/or Forte Home Health Care, Inc.. A consumer report and/or an investigative consumer report may be obtained at any time during the application process or during your employment, contract for services or volunteer services with the Forte Residential, Inc. and/or Forte Home Health Care, Inc. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by Safe Hiring Solutions LLC, P.O. Box 295, Danville, IN 46122 888-215-8296.

AUTHORIZATION

hereby voluntarily authorize Forte Residential, Inc. and/or Forte Home Health Care, Inc. to obtain either a consumer or an investigative consumer report about me from a consumer reporting agency and to consider this information when making decisions regarding my application for and/or continued employment, contract for services or volunteer services at Forte Residential, Inc. and/or Forte Home Health Care, Inc. I understand that I have rights under the Fair Credit Reporting Act, including rights discussed above, and have received a Summary of My Rights Under the FCRA. This report may be delivered in either written or electronic form.

Current Address
Previous Address (Last 7 years)
Check for CA, MN, or OK applicants only:
Check yes if you would like to receive a copy of the consumer report if one is obtained.