Personal Information
Employment Information
(Proof of U.S. citizenship or immigration status will be required upon employment.)
Background Information

Since you are applying for a position with a healthcare company, background checks will be conducted post-offer/pre-employment. This means that any offer of employment is conditional upon meeting company and client standards following thorough background investigations.

Employment History

Please provide accurate, complete information about your past four (4) employers and/or assignments, or employment history over the last 10 years, whichever is longer, listing the most recent first. Please include military duty.

Applicants wishing to drive in interstate commerce must provide information on all employers during the preceding three years, and must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of ten years' employment record). Any gaps in employment must be explained. 

Employer #1
Employer #2
Employer #3
Employer #4

Please provide contact information about three (3) persons who are familiar with your qualifications for employment. Please do not list relatives or friends.

Reference #1
Reference #2
Reference #3
Signature and Attestation

I attest that all the statements and information on my application are true and correct, and no attempt has been made to conceal or withhold pertinent information. Any falsification or misrepresentation is cause for termination in the event I am employed. I hereby authorize investigation of all the statements I have made herein. I authorize the companies or persons named to give information regarding my past employment, and I hereby release said companies or persons and Health Enterprises from all liability for any damage whatsoever for issuing or obtaining this information.

I understand that unless there is a written contractual agreement between Health Enterprises and me to the contrary, all employment at Health Enterprises is at-will. I understand that there is no guarantee of any continued future employment should I become an employee of Health Enterprises. I further understand that the Employee Handbook is for guidance purposes only and provides no promises or contract as to my employment. As an at-will employee, I understand that my employment may be terminated at any time for any reason without recourse by me.

I understand that Health Enterprises does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis by local, state or federal law.

I understand that Health Enterprises has a no smoking policy on its mobile units, that smoking is permitted only in designated areas, if any, at client locations, and that the Cedar Rapids office has a designated smoking area pursuant to the Iowa Smokefree Air Act. I also understand that if I am applying for employment as a driver, any offer of employment would be a conditional offer, subject to meeting DOT driver requirements. These include, but are not limited to, certain physical requirements, successfully passing a drug-screening test and being subject to random drug and alcohol testing for the duration of my employment.

Regardless of the position applied for, I understand that any offer of employment is conditional upon my ability to perform the essential functions of the position, with or without accommodations, and that for some positions this will be determined by a medical exam. I further understand that successfully passing a drug-screening test is required for all positions. I also understand that my motor vehicle record and background checks, including, but not limited to, child and dependent adult abuse (as needed for a specific position) and criminal record checks (local, state, and national), will be reviewed, and that any offer of employment is conditional upon meeting company and insurance standards.

I understand that if I am hired, I will be required to provide proof of identity and legal work authorization. I also understand that Health Enterprises will provide the Social Security Administration (SSA) with information from my I-9 Form to confirm work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.