Phone Number *

Country

(###)

###

####

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a United States Citizen? *

Yes

No

If hired, can you provide proof of citizenship? *

Yes

No

Have you ever been convicted of a misdemeanor/felony? *

Yes

No

Do you have a HIPAA certification? *

Yes

No

Do you have a Blood Borne Pathogen certification? *

Yes

No

Drivers License *

Yes

No

Application Agreement & Consent *

By submitting this application, I certify that the information provided in this application and any attachments (including my resume, licenses, and certifications) is true, complete, and accurate to the best of my knowledge. I understand that any falsification, omission, or misrepresentation of information may disqualify me from further consideration for employment or result in dismissal if discovered at a later date. I hereby authorize TruBridge Enterprise LLC (including its divisions TruBridge Logistics, TruBridge Home Health, and TruBridge Transit) to conduct the following background and screening processes as part of the hiring process: Consent Includes: Motor Vehicle Record (DMV) check To verify the status, history, and classification of my driver’s license. Criminal background check to determine criminal history or disqualifying offenses that may impact job duties or regulatory compliance. Employment History and reference check to validate relevant information. Drug screening test I understand that I must consent to a facility of TruBridges choice. To verify that I am free from the use of illegal or controlled substances as required for safety-sensitive positions. I understand that all such information will be handled confidentially and used solely for employment decisions in accordance with applicable laws and regulations, including the Fair Credit Reporting Act (FCRA) and HIPAA privacy guidelines. I also understand that completing this application does not guarantee an offer of employment.

Yes

No