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Pls Fill Application Out

PERSONAL INFORMAITON:

First Name:		Last Name:
Address 1:		Address2
City:		County:
Stat/Prov:		Zip Code:
Phone:		E-Mail:
SSN:		Sex:

EMERGENCY CONTACT:

Name:		Phone:

EMPLOYMENT:

Position Applied For? *
Date Available?* (mm/dd/yyyy)		Salary Desired: ($ per hour)
Are you currently working?:

Are You Able To Work*	Full Time: Part Time: Temporary: Overtime:

Have You Ever Applied To This Company Before?: If Yes, When: (mm/dd/yy)

EDUCATION:

Last Grade Completed in High School:* 6 7 8 9 10 11 12

Name of High School:		Location:
Last Year Completed College/Nursing /Trade School:		1 2 3 4

Name of College/Nursing/Trade School:
Location:


REFERENCES:

List a Personal and/or Professional References:

Name:		Relationship:
Yrs Known:		Phone:

Name:		Relationship:
Yrs Known:		Phone:

EMPLOYMENT HISTORY:

Enter Below Your Last Two Employers Starting With The Most Recent:

Employer:		Address
Immediate Supervisor:		Time Employed: From: To:
Final Wage:	($ Per month)	Was Separation:	Voluntary Involuntary
Job Title		Company Phone:

Employer:		Address
Immediate Supervisor:		Time Employed: From: To:
Final Wage:	($ Per month)	Was Separation:	Voluntary Involuntary
Job Title		Company Phone:

RELEASE AUTHORIZATION:

Will You Authorize FAITH STAFFING AGENCY To Contact Each Of Your Previous Employer And Request References?

*By Entering my Date of Birth: (mm/dd/yy), I hereby authorize FAITH STAFFING AGENCY to receive any criminal history records information pertaining to me, which may be in the files of any state or any local criminal justice agency in the state of Georgia.*

03/10/2011

Employee clock-in system...

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03/10/2011

DBA acquired....

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06-01-2009

Faith Staffing Agency becomes e-Compliant Health C...

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TO REACH US:

Our Vision

To be a preferred provider in home healthcare industry.

Our Mission

We achieve our goals by providing our client with quality, timely and value driven services with high integrity that respects individual needs and uniqueness.

Our Core Value ·

Diversified and specialized services

On-Site Visitation

We provide Ongoing Staff Training

Prompt Response with excellent customer service

24 hour On-call Emergency Contact

Experienced & Professional team

We can be reached 24 hours a day, 7 days a week on 678-851-1284, Case Manager/On-call staff