*If you have a resume you can skip education and write "see attached"

Name

Present Address

Education

Type of School

High School

College

Certificates

Employment dates

Pay or salary

Please list two professional references who are not relatives or previous employers.

First Professional References

Second Professional References

Agreement ( Please read carefully before signing )

I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of placement or termination of agreement.

I understand that neither the acceptance of this application nor the subsequent entry into any type of working relationship with the client creates an actual or implied contract of work. I understand that, if I accept the assignment, it will be on an at-will basis. This means that either the client or I have the right to terminate the relationship at any time, for any reason, with or without cause

I authorize ADS to investigate information concerning my education, employment experiences and all other aspects of my background relevant to my proposed employment. I release the ADS LLC, advocate team and client from all liability arising from such investigation.

We are an equal opportunity team. We adhere to a policy of making assignment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity as part of this team depends solely on your qualifications. Initial

You agree that you will not work for any client that ADS-Advocate Disability Services Team Member introduces you to for a period of one year as a temporary, independent, permanent, private caregiver, without written consent of ADS. A fee of 5k will be charged to client should they wish to hire you as a permanent care provider payable to ADS, if agreeable by ADS payable to ADS for staffing finders fee. If you violate this agreement you will be charged a fee of equal to 2 weeks your average pay plus court costs. Initial

You (the applicant) agree, you will refrain, will not, friend request or add to your friend list on your personal social media: Facebook, Instagram, Twitter, Email of any sort. You WILL NOT call any client after or before hours the client in which you have been placed with through ADS. Once you have been taken off a staffing assignment for a client, you WILL NOT continue a relationship socially. You agree it’s professionally against our team/company ADS policy and you will be terminated immediately if you violate this agreement. You will be placed on a do not hire list and reported for infraction to the CA State HCA registry board associations for non-compliance of company policy and infarction. Initial

You will not post ANY pictures of any client EVER on any social media. Any photos of clients must be deleted from your personal cell phone prior to the end of your staffing assignment. Any pictures posted is a violation of the clients personal rights and a direct violation of the HIPPA laws that protect the clients privacy. Clients may allow a picture to be posted with written authorization from the client and or family on ADS picture approval form through ADS administrative office only. Initial

You will not take gifts, items, money, garments, jewelry, gift cards anything from a client without written permission from ADS finance and administrative team first. The protocol must be met prior to approval. Initial

You will not put a client in your personal vehicle unregistered or uninsured. Initial

This form will not be read to you or reviewed with you. By signing you acknowledge you understand the rules of engagement. Initial