Employment Application

Ohio Valley Home Health is now hiring HHA’s, LPN’s and RN’s. Please complete and submit application below.

Personal Information

Employment Information

Part-time Full-time
Yes No
Yes No
Yes No
Yes No
(You will not be denied employment solely because of a conviction record, unless the offense is related to the work for which you have applied.)

Qualifications & Experience

School & Years Attended

Did you graduate?

Yes No
Yes No
Yes No
Yes No
(75 lb. weight limit) Yes No
Yes No

Past & Present Employers

Yes No

Yes No

Yes No

References

(Please do not list relatives or personal friends)


Emergency Contact

I certify that the facts contained in this application are true and complete and to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information they may have, personal or otherwise, and release all parties from all liability for damage that may result from furnishing same to you.