I hereby certify that the answers given by me to all of the questions contained on this application form are true and correct to the best of my knowledge. If employed by SYNERGY HomeCare of North Georgia, I will comply with all rules and regulations of the company. I agree to submit to a physical and or drug examination if required. I also authorize my former employers to give any information they have regarding me to SYNERGY HomeCare of North Georgia, whether or not it is on their records.
I authorize SYNERGY HomeCare of North Georgia to conduct any background checks necessary including, but not limited to: Felony and Misdemeanor convictions, previous arrest history, and driving records (DVM). I hereby release SYNERGY HomeCare of North Georgia from all liability for and damage whatsoever for issuing the same.
FOR EMPLOYMENT AS A CAREGIVER OR ANY POSITION REQUIRING DIRECT CONTACT WITH CLIENTS THEMSELVES OR THEIR PROPERTY/INFORMATION /RECORDS, STATE OF GEORGIA LAW REQUIRES A NATIONAL AND STATE BACKGROUND CHECK AS A CONDITION OF EMPLOYMENT.
Any controversy or claim arising out of or relating to this employment application shall be settled by arbitration administered by the American Arbitration Association under its Employment Arbitration Rules and Mediation Procedures and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Both the APPLICANT and SYNERGY HomeCare of North Georgia agree to bring any dispute in arbitration on an individual basis only, and not on a class or collective action basis on behalf of others. There will be no right or authority for any dispute to be brought, heard or arbitrated as a class or collective action and the arbitrator will have no authority to hear or preside over any such claim.
SYNERGY HomeCare of North Georgia is an Equal Opportunity Employer. I understand that job positions are placed equally without discrimination because of race, creed, color, religion, sex, national origin, sexual preference, handicap, or age.
I understand that if any fraudulent information is given on this application, it will be grounds for immediate termination from my position.
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