Job Opportunities

Important - Applicants Please Read

Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, marital status, ancestry, physical or mental disability, veteran status or sexual orientation. As a federal contractor, we are required to maintain records of the race and gender of all applications for our Affirmative Action Plans. The information requested is confidential and will be used solely for statistical purposes. Choosing to complete this form will not affect your consideration for employment.

Please Note - Completion of this page is required

If you do not wish to supply this information, simply select "I do not wish to provide this information" for each of the questions below. Refusal to provide specific ethnicity, gender, or race information will NOT subject any applicant or employee to adverse treatment. The information that you provide will be recorded and maintained in a confidential file, separate from all other records. This information will not be used in consideration for your employment.

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Race/Ethnicity Descriptions

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) - All persons having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) - A person who identifies with more than one race (i.e. White, Black/African American, Native Hawaiian/Other Pacific Islander, Asian, or American Indian/Alaska Native).

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Protected Veteran Descriptions

As a federal contractor subject to VEVRAA and the Rehabilitation Act of 1973, as amended, we are required to take affirmative action to employ and advance in employment qualified protected veterans. The information below is being requested on a voluntary basis and will be maintained confidentially. Refusal to provide this information will not subject you to any adverse treatment and will not be used in a manner inconsistent with the law. If you believe you belong to any of the categories of protected veterans described below, please indicate as such.

A Protected Veteran is identified as one of the following:

Disabled Veteran - A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under the laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

Recently Separated Veteran - A veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service.

Active Duty Wartime or Campaign Badge Veteran - A veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

Armed Forces Service Medal Veteran - A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces medal was awarded pursuant to Executive Order 12985 (61 FR 1209).

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Voluntary Self-Identification of Disability (OMB control number 1250-0005)

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

• Blindness
• Deafness
• Cancer
• Diabetes
• Epilepsy
• Autism
• Cerebral Palsy
• HIV/AIDS
• Schizophrenia
• Muscular dystrophy
• Bipolar disorder
• Major depression
• Multiple sclerosis (MS)
• Missing limbs or partially missing limbs
• Post-traumatic stress disorder (PTSD)
• Obsessive compulsive disorder
• Impairments requiring the use of a wheelchair
• Intellectual disability (previously called mental retardation)

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Section 502 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Please read the following statement carefully, then acknowledge that you have read and approved it by providing the information requested at the bottom of the page. Please note that an esignature is the electronic equivalent of a hand-written signature.

You are providing to Fountain of Health Home Health Agency, LLC. (a.k.a Fountain of Health) some of your personal information. Fountain of Health has taken the necessary steps to meet data privacy requirements. By completing this online form, you are authorizing Fountain of Health to review your data where it will be kept in confidence for a minimum of 3 years. The information collected in our recruitment system will be accessible to selected Fountain of Health employees who carry out duties relevant to the recruitment process and administration of the site.

This data will be used to: - Assess your qualifications and personal experience to determine if they meet specific job requirements. - Help us inform candidates of future job openings at Fountain of Health.

If at any point you decide not to complete the application, exit and do not sign and submit. The application will not be processed until it is complete and submitted by you in accordance with the procedures of this site.

Please read the following statement carefully and then acknowledge that you have read and approved it by providing the information requested at the bottom of the page. Please note that an eSignature is the electronic equivalent of a hand-written signature.

I certify that all the information I have provided on this application and on any accompanying documents is true and correct. I understand that any false statements I have made herein or my failure to disclose requested information may disqualify me from consideration for employment, or, if employed, may result in my termination.

I hereby authorize Fountain of Health, its agents and employees to contact any reference provided by me during the application process, and I authorize all references so contacted to release any information about me that they may have. I further authorize Fountain of Health or its agents to perform any investigation or background check of local, state and federal records relating to any criminal conviction I may have. I release Fountain of Health, its agents, officers and employees, and any reference contacted by Fountain of Health from any and all liability that may result from any investigation or reference check.

I understand and acknowledge that I may be required to undergo a post-offer, pre-placement physical exam, and a post-offer, pre-placement drug screening analysis for substance abuse. I understand that the result may, to the extent permitted by law, result in the revocation of any offer of employment.

I understand and acknowledge that Fountain of Health will screen my application with the Office of Inspector General ("OIG") and/or the General Services Administration ("GSA") to certify that I am not on the list of individuals excluded from participating in federal programs, including Medicare and Medicaid. Fountain of Health will not consider me for employment if I am on the "Exclusion List". I understand and acknowledge that nothing in this application or in any interview which I may be granted is intended to create a contract of employment between Fountain of Health and me. I further understand and acknowledge that, if I am offered employment, I am free to terminate my employment at any time, for any reason, and the company retains the same right.

I further understand that by completing the application process and entering the requested information below, I am certifying that I am the person identified on the application and whose name is typed below.