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This is my current employerStart DateEnd DateWould you be open to working with all ages of clients? Yes NoWould you be open to working with both male and female clients? Yes NoWould you be comfortable providing personal care? (i.e assistance with bathing, toiletings, etc.) Yes NoAre you a US citizen or legally eligible to hold employment in the USA? Yes NoCan you lift 50 pounds and meet the physical requirements of caregiving? Yes NoPlease select any active certifications you have as applicable. First Aid/CPR AZ Level One Fingerprint Clearance Card Article 9 Certification N/AIf you do not possess a Level One Fingerprint Clearance Card, is there anything in your background that would prevent you from obtaining one? N/A. I already have an active AZ Level One Fingerprint Clearance Card. No there is nothing in my background that would prevent me from obtaining one. Yes this is something in my background that would prevent me from obtaining one.Are you currently on the Office of the Inspector General's List of Excluded Individuals and Entities? If yes, please elaborate.Have you ever been convicted (found guilty) of attempting or committing any crime other than a minor traffic violation. If yes, give the date and elaborate.Have you ever been involved or do you have a substantiated finding with the Department of Child Safety (DCS) or Adult Protective Services (APS)? Please describe any experience you have in caregiving or related fields. This can be paid or volunteer experience.If employment is offered, professional references will need to be submitted and verified by Desert Survivors ahead of beginning shifts with any clients. By submitting this application, I certify: That this application is complete and accurate to the best of my knowledge, that I am eligible to work in the United States, and that I have not made any attempt to conceal information and that falsification could be the cause for dismissal. Further, Desert Survivors or its agents may request employment information from my previous employers and persons or corporations who provide information related to my previous employment and will be released from any liability or damage. Also, I agree if required to undergo a medical examination by a company designated physician and understand that medical approval must be obtained before employment can be affected. I have noted that Desert Survivors is an Equal Opportunity Employer and all applicants receive lawful consideration for employment without regard to race, religion, color, gender, age, national origin, sexual orientation, disability, gender identity and expression, marital, or veteran status. I realize that if I am hired, Desert Survivors reserves the right to terminate my employment whenever the need arises. Desert Survivors employees are required to comply with A.R.S. 36-601, the Smoke-free Arizona Act. Please contact the HR Manager for further information if you have any questions regarding this mandate. Acceptance I have read and agree to this statementSignatureSubmit