NL Employment App

NL Employment App

  • by
  • May 03, 2016

Please note that when you are filling out our application, be sure to use your 911 addresses for work and personal references.  You may not write “SEE RESUME” anywhere on the application as we need all the physical information on our application.  After filling out the application remember to electronically sign by checking the provided box as indicated at the end of the application under the signature line

When filling in the application make sure that all areas and sections with a red asterisk is completed or you will not be able to submit the application.  In the event that you forget a field the system will prompt you by notifying the areas to be completed and highlights the area in red.

If your application has been completed correctly and you press the submit button and receive no errors your application has been accepted and you will receive a confirmation notice. 

If you have any questions, need assistance or comments contact Northern Lights Home Health Care at 315-714-3135 or email

This application will not be considered unless fully completed.

Northern Lights Home Health Care is an equal opportunity employer for all applicants without regard to age, race, creed, color, national origin, sexual orientation, military status, sex, disability, predisposing genetic characteristics, marital status, domestic violence victim status, or any other protected status under federal, state or local laws.

In order to protect your personal identification, we will contact you for your social security number.

• If not, you must provide us with your “Working Papers”.

Answering "Yes" to the questions below does not constitute and automatic bar to employment.  Factors such as date of the offenses, seriousness and nature of the violation(s), rehabilitation and position applied for will be taken into account.

Please indicate hours available for work

Prospective employees will be screened by thoroughly completing an employment application which will include, but not be limited to: employment and personal references and information of any misdemeanor or felony conviction(s).  All references will be checked thoroughly prior to employment with this Agency.

Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer.
Present/Most Recent Employer Information
Additional Employer Information
Additional Employer Information
Additional Employer Information
Personal References

Give names and addresses of three (3) people whom we may contact for a personal reference.  Please include one individual that you currently or have worked with in the past, if applicable. (DO NOT LIST RELATIVES OR ANY JOB SUPERVISORS)

Reference 1
Reference 2
Reference 3
High School
Vocational / Tech
College / University

Please list below if you have any special skills or have you completed training/courses which might aid in the performance of duties of the position for which you are applying?



I understand that submission of an applications does not guarantee employment.  I also understand that this application is only valid for ninety (90) days from today's date.  If I still desire a position with Northern Lights after this application expires, it will be my duty to fill out a new application and file it.  Otherwise, Northern Lights will not consider me for employment after that date.

I authorize investigation of all statements contained in this application.

I understand that as a requirement of my job, in order to meet the needs of residents, I may be required to work overtime, subject to any limitations under state law.

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge.  I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.  It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In consideration for employment with Northern Lights, if employed, I agree to conform to the rules, regulations, policies and procedures of Northern Lights at all times and understand that such compliance is a condition of employment.  I understand that due to the nature of Northern Lights business, attendance and punctuality are considered essential requirements of every job at Northern Lights and that poor attendance or tardiness will result in disciplinary action up to and including termination.

I authorize Northern Lights to obtain and review my NYSDMV Abstract of Driving Record in the event that I will drive a Northern Lights' or my personal vehicle to perform company business now or in the future when it becomes a condition of employment.  I understand that the information on the NYSDMB Abstract of Driving Record report or future License Event Notification Service (LENS) notifications will be taken into consideration when deciding on continued employment.

I authorize Northern Lights to use my name and photo in any company literature and/or promotional activities.


I give Northern Lights the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application.  In connection with my application, I understand that investigative background inquiries may be obtained.  I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations, or organizations for furnishing such information.

I have read and understand the above statements.

Complete Statement Below Applicant's Signature

By placing a check in this box and e-mailing this application, I am providing a legally binding equivalent of my handwritten signature agreeing to the statements referenced above in this application. I also understand that I wil be required to review, update, and hand sign a hard copy of this application at the time of a granted interview (if applicable).

Please only click the submit button once and wait for a confirmation that your application was successfully submitted.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.