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Home Health Care Employment Application
First Name
Email
Applying for
Select position
Middle Name
Phone
SSN#
Last Name
Today's Date
Date of Birth
Street Address
Region/State/Province
City
Postal / Zip code
Country
Country
Education
Highschool
Graduate?
Yes
No
City/State
College
City/State
Start Date
End Date
Graduate?
Yes
No
Major
Degree
Add a College
City/State
Start Date
End Date
Graduate?
Yes
No
Major
Degree
Previous Employment
Name
City/State
Supervisor's Name
Supervisor's Contact Information
Position
Start Date
End Date
Work Eligibility
U.S. Citizen or Green Card
Yes
No
If NO:
Will Your Require Sponshorship?
Yes
No
How did you hear about this position at Mujang's Care LLC.?
Current Employee
Internet Website
Newspaper Ad
Transitioning from another agency with customer
Walk in
Word of mouth
Other
Where you referred to Mujang's by someone?
Are you interested in full-time or part-time?
Full Time
Part Time
Have you ever applied for a job with Mujang's Care before?
Yes
No
Have you ever been employed by Mujang's Care before?
Yes
No
What hours and days are you available to work?
7am-3pm (M-F)
3pm-11pm (M-F)
11pm-7am (M-F)
7am-3pm (Saturday)
3pm-11pm (Saturday)
11pm - 7am (Saturday)
7am-3pm (Sunday)
3pm-11pm (Sunday)
11pm-7am (Sunday)
May we contact your current employer?
Yes
No
Do you have a valid Driver's License?
Yes
No
If you answer yes to the question above, enter the name,address and phone number of your current employer.
Which state was your Driver's License issued?
Choose a state
Have you ever been convicted of or pled guilty, nolo contendere or no contest to a criminal offense other than a minor traffic violation?.(A yes will not necessarily disqualify you from employment).
Yes
No
Are they any pending criminal charges against you for an offense other than a normal traffic violation?. (A yes will not necessarily disqualify you from employment).
Yes
No
Are you related to anyone employed by Mujang's Care?
Yes
No
If yes, enter the name of the person you are related to
Please mark any of the below training in which you are currently certified.
Infection Control
CPR
First Aid
Pain Management
Patient Care Skills
Personal Hygiene Assistance
Nutrition & Meal Planning
Basic Medical Terminology
Cultural Competence
Geriatric Care
Chronic Disease Management
Wound Care
Other Certifications
Do you have experience working with Oklahoma's Harmony system?
Yes
No
Mujang's Care, LLC. primary purpose is to assist persons with developmental disabilities to reach their highest potential in everyday settings. Consequently, among the essential functions of an Mujang's Care job is the ability to bend at the waist, kneel, stoop and lift 50 pounds. Can you perform these essential job functions either with or without reasonable accomodation?
Yes
No
Mujang’s Care LLC is an Equal Opportunity Employer and is committed to excellence through diversity. Mujang’s Care LLC does not discriminate on the basis of age, disability, sex, race, religion or belief, gender, marriage/civil partnership, pregnancy/maternity, or sexual orientation. We are an inclusive organization and actively promote equality of opportunity for all with the right mix of talent, skills, and potential. We welcome all applications from a wide range of candidates. Selection for roles is based on individual merit alone. To ensure this application is acceptable, please print or type your responses. Please complete each section EVEN IF you decide to attach a resume. I understand Mujang's Care LLC is not obligated to provide me with employment and I am not obligated to accept employment. Nothing in this employment application or anything communicated to me during an interview is intended to create an employment contract between Mujang's Care LLC and me. If offered a position, I will be provided a separate employment contract. If I am hired, I will be required to provide documentation of my identity and employment eligibility in the United States in accordance with the Immigration Reform and Control Act of 1986. I authorize Mujang's Care to conduct a criminal background check, and any other background check required as a condition of my employment by statute, regulation or other law or governmental agency. I may also be subject to a pre-employment drug screening and a motor vehicle driving records check. I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.By signing this application you acknowledge that you have read, understand and agree to the following.(1). I hereby certify that the facts stated in this application are true and correct to the best of my knowledge. I agree that any false or inaccurate information in this application is sufficient reason for Mujang's Care to refuse to hire me and, if hired, to terminate my employment. ( 2).Mujang's Care is not obligated to provide me with employment and I am not obligated to accept employment. Nothing in this employment application or anything communicated to me during an interview is intended to create an employment contract between Mujang's Care and me. ( 3). If I am employed by Mujang's Care, my employment will be at-will which means that either Mujang's Care or I may terminate the employment relationship at any time, for any lawful reason, with or without prior notice. Mujang's Care’s employment-at-will policy may not be modified verbally by any person and may not be modified by a written statement appearing in an Mujang's Care policy or document other than a formal written employment agreement signed by Mujangs Care’s Executive Director. ( 4). If I am hired, I will be required to provide documentation of my identity and my employment eligibility in the United States in accordance with the Immigration Reform and Control Act of 1986. ( 5). Illegal use, impairment, or sale of narcotic, or controlled substances (without a doctor’s prescription) or alcohol while on Mujang's Care property, at a remote worksite to which I am assigned to work, or while driving during the course of my employment is strictly prohibited. I agree to abide by the Alcohol and Drug Free workplace and testing policies of this company. Any violation of these standards may result in immediate termination of my employment. ( 6). I authorize Mujang's Care to conduct a criminal background check and any other background check required as a condition of my employment by statute, regulation or other law or by a governmental agencys
I agree to the terms listed above
Your Signature
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