1. I hereby authorize the agency and/or the employer to obtain
reference information about me in order to verify the information
stated on my application for employment and release all persons from
liability for doing so.
2. I hereby authorize and give my consent to Dedicated Domestics,
its search firms and/or the employer to obtain records from any
criminal justice agency, local, state or federal court and/or motor
vehicle agency.
3. I understand that a pre-employment background check may be
performed which could include but is not limited to a search of
financial or credit agencies, educational institutions and workers
compensation records and will be performed through Trustline and/or
other agencies.
I understand that by signing below I authorize
Dedicated Domestics to perform the above mentioned background checks
and to disclose the reports to any prospective employers.
Print Name: ____________________________________
Date: ___________
Signature: ______________________________________
1. I have read and fully understand the questions asked on this
application. I certify that all the answers given by me are true,
accurate and complete and understand that the omission and/or
misrepresentation of any fact from this application or during any
interview will be cause for immediate dismissal.
2. I understand that Dedicated Domestics receives a fee from the
employer for providing me with an employment opportunity. Should I
directly or indirectly conspire with an employer to bypass the
agency and its due fee I will personally be held responsible for
payment of that fee and any legal fees and court costs required to
collect the same. Additionally, if the agency does not receive its
due fee as agreed, I will upon notification of the agency leave the
job within 24 hours or be responsible for payment of the agency fee
and any legal fees and collection costs. I also agree that for
temporary placements with employers I will leave the job at the end
of the agreed upon time, or upon notification from the agency. If I
fail to leave the temporary job I will be responsible for the
balance of the full agency fee and any collection costs.
3. I understand that Dedicated Domestics does not require an
applicant to pay any application or placement fees however, if I
accept a job and fail to show up on the agreed upon date, or if
during the first six months of employment I fail to give at least
two weeks notice if I intend to quit, I will be responsible for
payment of the agency costs involved in handling my background
checks and other paperwork and any expenses required to find a
suitable replacement at a minimum cost of $500.00 up to the full
agency fee.
4. While Dedicated Domestics does not charge an applicant any
fees, I understand that it is my responsibility and at my expense to
provide proof of an up-to-date TB Test. Additionally, for Nannies
and Child Caregivers, proof of an up-to-date "Pediatric CPR / First
Aid" certificate and registration with Trustline®
are required. For adult Caregivers an "Adult CPR / First Aid"
certificate must be provided. I further understand that failure to
provide the proof of TB test and CPR certification will be
considered grounds for immediate dismissal and I will be responsible
for the agency costs involved in handling my background checks and
other paperwork and any expenses required to find a suitable
replacement at a minimum cost of $500.00 up to the full agency fee.
By placing my signature below, I certify that I have
read, fully understand and agree with the above terms of this
agreement.
Print Name: ____________________________________
Date: ___________
Signature: ______________________________________