Application for Employment

Personal Information

Employment Information




Company 1

Company 2

Company 3


(Please provide three work-related references, preferably past supervisors/managers.)

Reference 1

Reference 2

Reference 3


I hereby certify that the information provided on this application is true and complete. I understand and agree that any falsification or significant omissions on this application may result in not being hired or, if found out after employment, may be grounds for dismissal. I understand and agree that under the terms of employment with Cover Care, LLC, the employment relationship is terminable “at will” without notice or cause, unless set out in writing, dated, and executed by both parties. I understand that neither this document nor any offer of employment from Cover Care, LLC constitutes an employment contract.
I understand that any offer of employment may be contingent upon my ability to comply with USCIS regulations establishing my identity and right to work in the United States. I understand that Cover Care, LLC is an Equal Employment Opportunity employer. Cover Care, LLC recruits and hires persons in all job titles without regard to race, sex, age, color, religion, national origin, disability, or other lawfully protected classes.
I hereby authorize Cover Care, LLC to investigate fully all information contained in this employment application and to investigate and compile any other information that may bear upon my suitability for employment. I further authorize my past and present employers to furnish Cover Care, LLC with my records of employment and the reasons for my separation and any and all information those employers may possess concerning me. I further release Cover Care, LLC and/or its agents to make an independent investigation of criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application. I release Cover Care, LLC from liability or damages for compiling such information. Additionally, I release any organization that provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above-referenced sources used. Further, I understand that this application will be considered active for a period of ninety days. I have read and understand the foregoing statements and accept the same as conditions of employment.