Peritech Home Health Associates, Inc.

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

Peritech does not discriminate against any person on the basis of race, color, religion, sex, national origin, age, disability, genetics, or any other characteristics protected by law in admission, treatment, or employment.  For further information about this policy, contact the agency's administrator at (800)634-5670.

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use the "Note Section" at the bottom of this application if you do not have enough room on the application. *Please note* In the signature line you will type in your full name and the last 4 digits of your social security number to serve as a legal signature. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.