Contact Us

Info@TMCCareServices.com

404-999-0906

TMC Job Application

Thank you for choosing TMC Care Services, LLC. We look forward to working together with you in providing quality and efficient care for our patients. Our company was established to bring quality care into the homes of individuals who need assistance. We will work hard to get you the hours you desire and pair you with the best clients to fit your specialty of care. In addition to completing the hiring packet we will need copies of the following forms to complete your file:

Driver’s License and SS Card (for I-9)
Current License (if applicable)
Copy of CPR Card
Copy of TB (PPD skin test) within one year
Current BLS (Basic Life Support) if applicable
Current ACLS (Advanced Cardiac Life Support) if applicable
Current PALS (Pediatric Advanced Life Support) if applicable

The application process can seem overwhelming at first, but all the documents required are the same that are needed for hospital employment. We have built a good reputation for our meticulous record keeping and meeting stringent nurse, cna, and pca hiring requirements which also allowed us to gain more contracts and offer more shifts with fewer cancellations. We are honored that you have decided to join our team and allowing us to represent you in the healthcare industry.

If you have any questions, please feel free to contact our office at: 404-999-0906

Sincerely,

Hannah Grant, Administrator

First Name *

Last Name *

Have you ever used another name?

I confirm that I want to receive content from this company using any contact information I provide.

Phone *

Email *

Date of birth *

Social Security Number *

Address *

City *

State *

Postal code *

Mailing Address

Emergency Contact *

Employment Desired

What position are you applying for? *

If hired, on what date can you start work? *

Salary Desired?

$

References

List below three persons not related to you who have knowledge of your work performance within the last three years. If this does not apply to you, then provide three school personal references that are not related to you.

Reference #1 *

Reference #2

Reference #3

How did you hear about our company? *

Education and Training

High School Name and State *

Level of High School Completed *

High School - Date Graduated *

College/University Name and State

College/University Degree Obtained

College/University - Date Graduated

Vocational/Business Degree Obtained (If So When?)

Employment History

List below all present and past employment, starting with your most recent employer:

(List Last 5 Years)

Are you employed now? *

May we contact your employer? *

Employer #1 *

Company Name
Address
Phone Number
Position Held
Your Supervisor’s Name
Start Date
End Date
Starting Earnings
Ending Earnings
Exact Reason for Leaving

Employer #2 *

Company Name
Address
Phone Number
Your Supervisor’s Name
Position Held
Start Date
End Date
Starting Earnings
Ending Earnings
Exact Reason for Leaving

License Information

Answer the following questions if applying for a professional position

Are you licensed for the job applied for? *

Type of license

Issuing state

License/certification number

Has your license ever lapsed, been revoked or suspended?

If yes, state reason(s), date of lapse, revocation or suspension and date of reinstatement

Criminal History

Have you ever, under your name or another name, been convicted of (or pleaded guilty or nolo contendere to) a Felony or Misdemeanor? *

Have you ever, under your name or another name, been convicted of a crime, which resulted with your being in prisoned and released from prison or paroled?

(Do not identify convictions for marijuana-related offenses that are more than two years old; or convictions for which the criminal record has been expunged, sealed or eradicated by the court; or, misdemeanor convictions for which any probation has been completed and the case dismissed by the court.) *

If yes, explain each conviction fully, when, where and of what you were convicted and disposition of the case(s):

Are you currently under arrest, or released on bond or your own recognizance, pending trial for a criminal offense? *

If yes, state the nature of the crime charged, the date of and where the trial is pending:

The following section is for employment within the healthcare industry in Georgia

Have you ever been arrested for a sex related crime? *

If Yes, Please Explain:

Have you ever been arrested for a drug related crime? *

If Yes, Please Explain. drugs

Authorization

Personally, completed this form honestly and accurately

By my signature below, I promise that I have personally completed this application. I declare under penalty of perjury that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justified for my dismissal from employment if discovered later. I understand that any job offer is conditional based on the satisfactory review of my qualifications including all background or drug screening which may be required.

Drug and Alcohol Screening

I give permission for a pre-employment drug/alcohol screening exam, and, if the company makes a conditional job offer, I give permission for a complete employment physical and mental examination. I also consent to the appropriate release of all medical information, as may be deemed necessary. (See separate agreement)

Authorization to obtain information

I voluntarily and knowingly authorize any present or past employer; supervisor; administrator; educational institution; law enforcement agency; state, local, or federal agency; credit bureau; collection agency; private business; military branch; the national personnel records center; personal reference; and/or other persons; to give records or information that may have concerning my criminal history, motor vehicle report, educational history, licensing, employment (including character, earnings history and reasons for termination) or any other information requested by the company requested to determine my eligibility for employment.

Release

I voluntarily waive all recourse and release any company, individual or organization from liability for complying with any request from the company or agents of the company (including any consumer reporting agency) to obtain any information from any source whatsoever relating to my application for employment. I further release the company or any individual within the company regarding the use any information received which may have bearing on my application for employment.

Notification and compliance with rules

I agree to immediately notify the company if I should be convicted of a crime while my job application is pending, or during my employment if hired. If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies and procedures of the company. I certify that all the information provided by me on this Application is true and accurate.

Signature *

Clear

Todays Date *

Print Name *

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