Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Street Address *

City *

State *

ZIP Code *

Driver's License

Driver's License (Front & Back) *

Please upload a clear photo of both sides of your driver's license. Accepted formats: JPG, PNG, PDF (Max 10MB)

Social Security Number

Social Security Number *

Format: XXX-XX-XXXX. This information is securely encrypted and stored.

Banking Information

Please provide your bank account information for direct deposit payroll.

Bank Routing Number *

9-digit routing number

Bank Account Number (Checking) *

Your checking account number

Background Check Consent

I consent to a background check and understand that Blue Wave Home Care will conduct a background investigation as part of the employment process. I authorize the release of information from any source that may be relevant to my employment application. *

Signature

By typing your name and the date below, you are signing this employment contract electronically.

Type Your Full Name *

This serves as your electronic signature

Today's Date *

Date of signature

I certify that the information provided in this employment contract form is true and complete to the best of my knowledge. I understand that any false statements may result in termination of employment. *

I understand that my personal information, including Social Security Number and banking information, will be securely stored and used solely for employment and payroll purposes. I consent to the collection and processing of this information. *

Employment Contract

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