Information about a patient/client’s condition, care, treatment, personal
affairs, or records is confidential and may not be disclosed with anyone except
your supervisor and/or those responsible for the patient/client care and
treatment, without the full consent of the patient/client or when compelled by
legal requirements. You will safe-guard confidence as a trust and reveal such
confidence only after careful deliberation and when there is a clear and
imminent danger to an individual or society. I agree that I have been informed
of the requirements of the work for which I am applying, and that the
information in this application is correct and complete to the best of my
knowledge. I understand that is shall be grounds for immediate dismissal if any
of the information contained herein is found to be untrue. I authorize you and
all former employers, given by me as references, to answer all questions and to
give all information contained in connection with this application or in anyway
concerning me. I understand that if accepted for employment, I will be working
for you on your payroll, at the client’s premises.
I agree that I will obtain
your permission before discussing permanent employment with your client. I agree
to immediately notify you at the conclusion of each assignment as soon as I
become available. If I fail to give to give you such notice, you may assume that
I am not available for reassignment, and am not ready, willing and able to work.
Failure to do so is considered job abandonment and under current law,
unemployment benefits can be denied. I understand that any information that I
learn while working for a client is to be kept confidential. I agree, if
employed, that if I ever make claims against you for personal injuries, upon
request I shall submit to examinations by physicians of your choice. I will hold
HomeNurse harmless from any claims including but not limited to person injuries
or illness as a result of my providing false or misleading information on this
application. I hereby acknowledge that my employment is at “will” and
“temporary” , that I may resign at any time and the company may terminate my
employment at any time, with or without reason, except that no employee will be
discharged for reasons that are prohibited by state and federal laws.
I understand and agree that I have never been shown by credible evidence (i.e.
court or jury, department investigation, or any reliable evidence) to have
abused, neglected, sexually assaulted, exploited, or deprived any person or to
have subjected any person to serious injury as a result of intentional or
grossly negligent misconduct. I hereby authorize HomeNurse, Inc., by accepting these
conditions, to receive criminal history information pertaining to me from any criminal justice agency
in any state.
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