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Application

Please complete the form below.

If preferred, download and print the application here

Fax: 610-257-7097

APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment with Healing Energy Homecare. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if
discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be
treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other
protected class status under applicable law. 

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Are you at least 18 years of age?
Do you have a legal right to work in the United States?
Have you ever been convicted of a felony?
Have you ever been convicted of Medicare or Medicaid fraud?
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Are you certified?
Do you drive?
Do you have a valid driver's license?
Do you have an active 2 Step PPD (TB) test within the past year?

APPLICANT CERTIFICATION AND RELEASE:
I certify that I have read and understand the applicant note on page one (1) of this form and that the answers given
by me to the foregoing questions and the statements made by me are complete and true to the best of my
knowledge and belief.
I understand that any false information, omissions or misrepresentations of facts in this application may result in
rejection of my application or discharge at any time during my employment. I authorize the company and/or its
agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to,
criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law
enforcement authorities to release any information concerning my background and hereby release any said
persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for
issuing this information. I release this company from any liability which might result from making such
investigations.
I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug
testing to detect the use of illegal drugs prior to and during employment. I understand that this application is not a
contract of employment. My employment is contingent upon confirmation of credentials and successful
completion of drug test or criminal background check. I also understand that if hired, regardless of any oral

presentations to the contrary, the employment relationship between the Company and myself is terminable at-
will, so that both the company and I remain free to choose to end out work relationship at any time for any or no

reason. Any changes in this employment relationship must be made in writing. My signature below acknowledges
that I have read, understand, and agree to the above disclosure. I also understand that due to the nature of the
business, no amount of work can be guaranteed.

Received! Thanks for applying.
We’ll get back to you soon.