* Required Information
Personal Information
Skills Information
Please be aware that the following tests may be required as part of the Isinc Pre-Employment process.
  • National Background Check
  • PPD Skin Test
  • Chest X-Ray
  • Medical/ Physical Exam
  • Hepatitis B
  • Drug & Alcohol Test
  • Availability
    Geographic Location(s) Willing to Work
    Please select YES if able to work
    Please indicate the times you are available to work each day
    Employment Background
    Other Information
    Driving Information (For driving jobs only, do not complete if you will not be driving for work.)

    In exchange for the consideration of my job application by Isinc (hereinafter called “the Agency”), I agree that:

    Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Agency practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Isinc, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/CEO of the Agency. Both the undersigned and Isinc may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Agency may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

    I also understand that the Agency conducts a thorough background investigation to include but not limited to medical, physical, drug/alcohol screening and driving records that may be required by Isinc as a condition of employment. In consideration of Isinc review of this application, I further understand I may be required to successfully pass a random drug/alcohol screen at any time for reasonable suspicion. I release Isinc and all providers of information from liability as a result of furnishing and receiving such information. This does not waive my right to file a charge, testify, assist or participate an investigation, hearing, or proceeding under Title VII, the Age Discrimination in Employment Act, the Equal Pay Act or the Americans with Disabilities Act. Isinc will perform these background investigations according to non-discriminatory criteria. I understand that Isinc is a drug-free work environment and that, if hired, I will uphold all policies both written and verbal regarding this effort.

    Sections 63.1-198.2 of the Code of Virginia require that a sworn disclosure statement or affirmation be completed for each prospective employee and volunteer. Employment or volunteering is prohibited if a person has been convicted of any of the offenses specified (see attached) or has been the subject of a founded complaint of child abuse or neglect. Convictions include adult convictions, juvenile convictions and adjudications of delinquency based on an offense that would have been at the time of conviction a felony conviction if committed by an adult within or outside the Commonwealth. Any person making a materially false statement regarding any such offense shall be guilty of a Class 1 misdemeanor.

    Note: If a person is not employed or accepted as a volunteer Isinc will not keep this information. Furthermore Isinc will not disseminate the information provided.

    I hereby affirm that the information provided on this form is true and complete. I understand that the information is subject to verification.

    I further understand that my employment with the Agency shall be “at–will” and this does not create an employment agreement nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice.

    I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE. I authorize investigation of all statements contained in this application. I have never been terminated from employment due to allegations of unauthorized physical contact, abuse, neglect of a patient, client or resident. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Agency permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Agency from any liability as a result of such contract.

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