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In-Home Application

In-Home Care Job Application

Contact Information
Number of Work Hours
First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
For the purpose of compliance with the United State Immigration and nationalization Act, are you legally eligible to work in the United States?
Were you referred to ADTS for a job?
Have you ever been fired or resigned from a position after being notified you were being terminated?
No file selected
You may contact my PRESENT employer:
Have you ever been convicted of a felony/misdemeanor, other than minor traffic violations?

Please remember to attach your resume to this application – you may email your resume directly to
lfreudenvoll@adtsrc.org.

Applicant’s Statement

I have read the job description attached to this application for the position I am applying for,
and I can perform the essential job functions with or without reasonable accommodation.

I understand that Aging, Disability & Transit Services of Rockingham County follows an “employment at will” policy, in
that I or the employer may terminate my employment at any time, or for any reason consistent with applicable agency
policies and/or state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the
change is specifically authorized by the Executive Director of Aging, Disability & Transit Services of Rockingham County. I
understand that this application is not a contract of employment. I understand that federal law prohibits the
employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and
identify; failure to submit such proof will result in denial of employment.
I understand that Aging, Disability & Transit Services will investigate my work and personal history and verify data given
on this application or related papers and in interviews. I authorize all individuals, schools, and employers named
therein, except my current employment if so noted, to provide any information. I further understand and agree that
Aging, Disability & Transit Services will conduct criminal background checks as required by North Carolina law and/or
agency policy.
All prospective employees will be required to have a pre-employment drug screening and TB Screening.
All employees are subject to random drug and/or alcohol testing during their employment with Aging, Disability &
Transit Services of Rockingham County. A positive drug and/or alcohol test without an acceptable note from a doctor
explaining the circumstances will make an applicant ineligible for employment with ADTS.
I certify that all statements herein are true and understand that any falsification or willful omission shall be sufficient
cause for dismissal or refusal of employment.

Elderly people walking and holding hands.

Get Involved. Make a Difference

ADTS relies heavily on community support to meet the growing needs of older adults and adults with disabilities in Rockingham County. Therefore, we have a variety of ways you can get involved with our programs and services throughout the year.

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