Application Form

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, medical condition, national origin, or marital status.

Personal Information

Section 1 - General Information

Section 2 - Employment Verification

Section 3 - Emergency Contact Information

Section 4 - Education

Section 5 - Licenses and/or Certifications

Section 6 - Work Experience/Skills

Section 7 - Current Employment

Section 8 - Employment History 1

Section 9 - Employment History 2

Section 10 - Employment History 3

Section 11 - Employment Reference 1

Section 12 - Employment Reference 2

Section 13 - Educational Reference 1

Section 14 - Educational Reference 2

ACKNOWLEDGMENT (Please read carefully before signing)

I understand that when I submit this application I am electronically signing the application.

In signing this application, I certify that I have read and fully understand the questions asked in this application and that all answers given by me are true, accurate, and complete.  I also understand that the omission, concealment, or misrepresentation of any fact on this application or during any interview for employment may jeopardize my chances for employment and be cause for my immediate dismissal from employment.


I, _______________________hereby authorize Saba Home Health Care Inc to request and receive from all prior employer(s), schools, companies, corporations, law enforcement agencies and credit bureaus or other persons who can verify or provide information within three years of the date of this application, regarding any and all pertinent information concerning my prior employment and its termination, including the reasons for such termination and more. I hereby release said companies, organizations, agents, individuals, and Saba Home Health Care Inc. from any damage whatsoever resulting from providing such information.

In consideration of my employment and of my being considered for employment by Saba Home Health Care Inc, I agree to abide by all rules, regulations, policies and procedures which I understand are subject to change at any time for any reason without prior notice.  I also understand that if employed, I will be an employee at-will and employed for no definite period of time.  I understand that either Saba Home Health Care Inc or I can terminate my employment at any time, with or without cause and with or without advance notice. Any modifications of the at-will employment relationship, oral or written, can only be accomplished by a written document signed by Saba Home Health Care Inc. President/CEO or Board of Directors.   I further understand that no communication, whether oral or written, by any representative of Saba Home Health Care Inc, at any time, can constitute a contract of employment.  No representative or agent of Saba Home Health Care Inc, has the authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.

I agree, in consideration of your employing me, that I will not seek or accept employment, either directly or indirectly in any capacity from any client of Saba Home Health Care Inc to who I have been assigned, for at least 180 working days after the last day of that assignment. I also agree that I will not solicit these clients on my behalf or on behalf of any future employer. 

I understand that Saba Home Health Care Inc does not provide auto insurance coverage for me and that I am not to transport clients in my automobile without written consent from the Saba Home Health Care Inc office. No background checks will be conducted until you verify your identity by personally providing a photo ID to Saba Home Health Care Inc.