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Emergency Contact

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Have you ever been convicted of or pleaded no contest to a felony within the last five years?
Are you able to perform the essential functions of the job for which you are applying?

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I certify that the information contained in this application is true and complete. I understand that false information may be grounds for not being hired and/or immediate termination of employment if hired. I understand that false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing of a BCI background check. I authorize the verification of any and all information listed above.


I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERATAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.
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(Note: Hattie Mae’s Home Care Agency complies with the ADA (Americans with Disabilities Act of 1990) and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.
Hattie Mae’s Home Care Agency is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from considerations for employment on a basis of race, sex, age, religion or disability and/or which is prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact an agency representative.

Hattie Mae’s Home Care Agency, LLC
Phone: 833-537-8233

Email: info@hattiemaehomecare.com

Required Documents

  • Driver's License
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  • TB Test
  • Certification/License
  • CPR basic life support American Hearts Association

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