Programs & Services

Private Duty Care
 Bathing
 Light housekeeping
 Laundry
 Meal Preparation
 Caring Companionship
 Bathing & Dressing
 Walking Assistance
 Transferring
 Earrands & Transportation
 Grocery Shopping/Errands
 Medication Reminder
 Doctor Appointments
 Alzheimer's & Dementia Care
 Fall Prevention
 Change Linens & Bed Making
 Play Games or Cards
 Attending an Event
 Home Safety Evaluation

CAREERS WITH RELIANCE HOME HEALTH CARE

Position
Description
Details
Home Care Specialist (Marketing)
Home Care Specialists market home health services to physicians, hospitals, skilled nursing facilities, discharge planners, case managers and other potential referral sources. May be required on occasion to attend some after-hours or weekend events.
Registered Nurses 
Reliance Home Health Care is seeking Compassionate, Reliable RNs with AT LEAST one (1) year prior Home Care experience for hourly home care in the North & South Palm Beach County areas. Knowledge of computer skills and Oasis forms a MUST. Bilingual a plus but must be proficient in English. Currently, these positions are on a per diem schedule.

 

EMPLOYMENT APPLICATION
Print, Fill Out & Fax

AVAILABILITY FORM
Print, Fill Out & Fax

Adobe Reader
You will need Adobe Reader to view and print the PDF form above.
If you don't have, click the icon above for a free download

Print

ONLINE APPLICATION

Contact information:
First name:
 * required
Last name:
 * required
Middle initial:
Address:
 * required
City:
 * required
State:
Zipcode:
 * required
How long?:
 * required
Previous address:
Previous city:
Previous state:
Previous zipcode:
Home phone:
Cell phone:
Social Security Number:
 * required
Position(s) applied for:
Expected salary/hourly rate:
Next of kin name / phone#:
Your email address:
Date of application:
 * required
 
How did you hear of us:
Do you have a valid Florida Driver's License?:
Have you ever been employed with us before?:
If yes give date
Have you ever filled out an application with us before?:
If yes give date
Are you currently employed?:
May we contact your current employer?:
On what date would you be available for work?:
 * required
Are you available to work?:
Are you currently on "Layoff" status and subject to recall?:
Are you prevented from lawfully becoming employment in this country because of visa or immigration status?:
Proof of citizenship or status will be required upon employment
Are you capable of preforming in a reasonable manner the activitites invloved in the job or occupation for which you have applied?:
Have you ever been convicted of a felony or had adjudication withheld?:
Convicition will not necessarily disqualify an applicant from employment
If yes, please explain
May we contact your current employer?:

Professional References:

(Please list three persons whom you have known for at least one year.)

1. Name:
 * required
Phone:
 * required
Address:
 * required
Years Known:
 * required
2. Name:
 * required
Phone:
 * required
Address:
 * required
Years Known:
 * required
3. Name:
 * required
Phone:
 * required
Address:
 * required
Years Known:
 * required

Employment Experience:

Please start with your current or most recent job. You may include and job-related military service or volunteer activities

1. Employer:

Address:

Phone:

Dates employed:

Job Title:

Supervisor:

Hourly rate/salary:

Work Performed:

2. Employer:

Address:

Phone:

Dates employed:

Job Title:

Supervisor:

Hourly rate/salary:

Work Performed:

3. Employer:

Address:

Phone:

Dates employed:

Job Title:

Supervisor:

Hourly rate/salary:

Work Performed:

4. Employer:

Address:

Phone:

Dates employed:

Job Title:

Supervisor:

Hourly rate/salary:

Work Performed:

5. Employer:

Address:

Phone:

Dates employed:

Job Title:

Supervisor:

Hourly rate/salary:

Work Performed:

Education:

 

Name & Address of School

Course of Study

Years completed

Diploma Degree

High School
 Undergraduate College
 Graduate or Professional
 Other (Specify)

Person to Contact in Case of Emergency:

Name:
 * required
Relation:
 * required
Home Phone:
Cell Phone:
 * required
Work Phone:
Address:

Other Qualifications and/or Special Trainings:

Please type in any additional qualifications and/or special training.

Statements:

I understand that the company will implement a drug-free workplace policy and submission to blood/urine testing may be a condition of employment and continued employment. I hereby agree to submit testing and examination at the employer’s expense at any time during the hiring process and my employment. I understand that my refusal to do so or my failure of the test(s) may result in my employer’s refusal to hire me, or my immediate termination.

Applicant's Signature & Date (mm/dd/year):
 * required

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

I understand that the company will do a background check and a division of motor vehicles check to me prior to hiring. I hereby agree as a condition of application for, and if hired, employment and continued employment, to have such checks run at any time. I understand that my refusal to so agree or the presence of a negative report may result in my immediate termination or refusal of employment.

Applicant's Signature & Date (mm/dd/year):
 * required

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

I understand that I will be place on a 90 day probationary period. I further understand that, in accordance with FS S 433.131.(3)(a)(2), if I am terminated during this period for inability to perform, the employer’s unemployment account shall not be charged for any unemployment paid to me.

Applicant's Signature & Date (mm/dd/year):
 * required

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

I certify that the answers given herein are true and complete to the best of my knowledge. It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from this employer’s service if I have been employed. Further, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has authorization to make any assurances to the contrary.

I give the employer the right to investigate all references and to secure additional information about me if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information.

Applicant's Signature & Date: (mm/dd/year)
 * required

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

divider_image.gif