Careers

We are looking for professionals who are dedicated and compassionate about giving care services to individuals with disabilities, injuries, difficulties with mobility, or illnesses. If you are planning to pursue a career in the healthcare industry, then we encourage you to join our growing team today. We are an equal opportunity employer. Discrimination due to race, sexual orientation, and age is not tolerated within our organization. For interested applicants, please send your resume to info@thutahhs.com. Or, you can fill out the form with the necessary details below.

* = Required Information

Application for Employment

Please print or type all information except signature.

NOTE: This form is intended for use in evaluating your qualifications for employment. Please answer all questions completely and accurately. False or misleading statements on this form and during the interview are grounds for terminating the application process or, if discovered after employment commences, terminating employment. Thuta Healthcare Services LLC is an equal opportunity employer and does not discriminate on the basis of gender, race, age, creed, marital status, pregnancy, sexual orientation, national origin, religion, veteran status, presence of disabilities, and on any other status protected by law. Upon hiring, you must pass a background check (BCI) and submit a recent negative tuberculosis (TB) test.

Date

First Name *

Last Name *

Middle Initial

Maiden Name

Street Address *

City *

State *

Zip *

Previous Street Address *

City *

State *

Zip *

Phone Number*

Cell Number *

Alternative Phone

Email Address *

Social Security Number *

How did you hear about Thuta Healthcare Services LLC ?

Why are you interested in employment with Thuta Healthcare Services LLC?

Do you have a valid driver’s license? YesNo

If Yes, Please fill up

From What State?

License number

Make and Year of Vehicle

Auto Insurance Co.

Policy Number

Have you had any moving violations in the last 3 years? YesNo

If Yes, Please describe

Note: Upon interview, please provide a copy of your driver’s license and auto insurance policy.

AVAILABILITY

Approximately how many hours per week do you wish to work?

Would you accept long-term assignments? YesNo

Short-term assignments? YesNo

Please indicate the days and times that you are available for work:

Monday

Tuesday

Wednesday

Thursday

Friday

Do you have reservations about providing services to a client with a pet(s)? YesNo

Are you willing to provide service to a client that smokes? YesNo

EDUCATION, LICENSES, & CERTIFICATIONS

High School

City, State or Country

Graduate YesNo

Number of years Completed

College

City, State or Country

Graduate YesNo

Number of years Completed

Type of Degree

License or Certification 1 (if applicable)

Number

State

Currently Active? YesNo

Expiration Date

Has your license or certification ever been suspended or revoked? YesNo

If Yes, Explain

PERSONAL REFERENCES (Do not include relatives)

Name

Address

Telephone Number

Relationship

Name

Address

Telephone Number

Relationship

Name

Address

Telephone Number

Relationship

SECURITY (As a condition of employment all employees must be “bondable.”)

Please list states and counties of residence for the past seven years:

Have you used any names or Social Security numbers other than those on this application? YesNo

If Yes, Please list

Have you been convicted of a felony and/or theft, assault, or drug related misdemeanor? YesNo

If Yes, Please describe below.

Incident

City/State

Charge

Incident

City/State

Charge

Incident

City/State

Charge

A conviction is not an automatic bar from employment.

Comments

WORK EXPERIENCE (Please list present and past employment beginning with your most recent.)

From

Job Title

Name of Employer

Phone

Address of Employer

Reason for leaving

Job Duties

From

Job Title

Name of Employer

Phone

Address of Employer

Reason for leaving

Job Duties

From

Job Title

Name of Employer

Phone

Address of Employer

Reason for leaving

Job Duties

From

Job Title

Name of Employer

Phone

Address of Employer

Reason for leaving

Job Duties

May we contact your current employer? YesNo

CERTIFICATION, AGREEMENT, & RELEASE

I, hereby authorize Thuta Healthcare Services LLC to request and receive from all prior employers within one year of the date of this application, any and all pertinent information to my prior employment and its termination, including the reasons for such terminations. 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, and all schooling and references. I agree to indemnify and hold harmless Thuta Healthcare Services LLC and any of its agents or employees from all liability, which may flow from the release of such information.

I understand that if I am hired my employment will be on an at-will, per-diem basis, for no definite term. Hours cannot be guaranteed and are subject to change. As such, I understand that I will enjoy the right to terminate my employment at anytime. Thuta Healthcare Services LLC may also terminate my employment at any time with or without cause and/or prior notice. I further acknowledge that if offered employment I will be expected to learn and abide by all Company rules, policies, and procedures. I also understand that the use of illegal drugs is strictly prohibited while employed by Thuta Healthcare Services LLC and I am willing to submit to random drug testing to detect the use of illegal drugs prior to and during employment. Nothing contained in this employment application or in the granting of an interview is intended or designed to constitute an offer of employment or an employment contract between Thuta Healthcare Services LLC and myself.

I hereby state that all of the foregoing information I have supplied in this application is a true and a complete statement of the facts. I understand that false statements contained in this application are immediate cause for dismissal.

Date

Name of Applicant*

FOR OFFICE USE ONLY

Date of Interview

Comments

Reference / Employment Check

Employment # 1

Name

Date Contacted

Date Verified

Results

Verified by

Employment # 2

Name

Date Contacted

Date Verified

Results

Verified by

Employment # 3

Name

Date Contacted

Date Verified

Results

Verified by

Personal # 1

Name

Date Contacted

Date Verified

Results

Verified by

Personal # 2

Name

Date Contacted

Date Verified

Results

Verified by

Personal # 3

Name

Date Contacted

Date Verified

Results

Verified by

217-803-0348

Thuta Healthcare Services LLC Contact Details