EMPLOYMENT APPLICATION

Our company (“CSS Healthcare Services”) fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law. As an Equal Opportunity Employer, we intend to comply fully with applicable federal, state and/or local employment laws and the information requested on this application will only be used for purposes consistent with those laws. To the extent required by applicable law, CSS Healthcare Services maintains a drug-free workplace.
Personal Data
*Note: It is not necessary for you to identify unavailability for work because of religious observance or practice or any other protected classification. Subsequent to any job offer, we will consider whether a reasonable accommodation can be made.
*Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

DRIVING RECORD
Answer only if driving is a requirement of the job for which you are applying. (All CNA and Direct Support applicants MUST complete the driving record)