Thank you for your interest in working for Avalon Angels Nursing &Caregiver Services Inc. In completing this form, you have agreed not to hold the agency or the clients responsible for any accidents that may happen in the workplace. You are responsible for your taxes/social security as an independent contractor.
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to engagement of my services, I understand that false or misleading information in my application or interview may result in my release.
I understand that any misrepresentation or omission of fact may result in legal action and/or justification for separation from Avalon Angels Nursing & Caregiver Services Inc.
I understand that all information on this form is subject to verification and I consent to criminal history background checks.
I understand that in signing a contract with Avalon Angels Nursing & Caregiver Services Inc. (the Agency), I will accept all responsibilities as a self-employed person, doing independent contract labor referred by Agency, I will not at anytime hold the Agency, Hospital, Patient, Family of the patient or agent of the patient, responsible in any way for my actions. I am completely responsible for my own State and Federal Income Tax, and Social Security withholdings.
I agree that I will not solicit or accept private employment from any client of the Agency. Should I solicit or accept an offer of employment from the agency’s client; I agree to indemnify the agency the amount of Three Thousand Dollars ($3,000) as placement fee.
I further agree that all disputes or cases arising from civil or criminal liability shall be filed in the Los Angeles county area.
I have read the foregoing and understand that I am giving permission to the Agency to write or speak to my former employers for employment references purposes.
