All of the information that I have provided on this application, and on any résumé that may accompany this application, and/or any information provide by me during any interview is accurate and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.
National and State Background and Reference Check Authorization
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provide by me in this application, résumé, or interview.
I expressly authorize, without reservation, the Employer to perform a National and State Background check, a driving record check, and a confirmation of any education background, professional licenses, and personal and professional references listed herein.
I specifically authorize the Employer to contact any and all of my previous employers, unless marked otherwise on this application, and I authorize my previous employers to disclose all records and other pertinent information about my employment to the Employer. I also authorize the Employer to provide truthful information concerning my employment to any future prospective Employers and agree to hold the Employer harmless for providing such information. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I specifically acknowledge that I will execute the attached Notification, Authorization, and Consent for Release of Criminal History Record Information (TLAB-APP-2) and the Notification, Authorization, and Consent for Release of Criminal History Record Information (TLAB-APP-3) provided by the Employer with this Application, having read and accepted the notice and authorizations included therewith.
Drug/Alcohol Test and Physical Exam Acknowledgment
I acknowledge that the Employer will require me to submit to a drug and alcohol test and a medical examination in conformance with federal and state law and the Personnel Policies of the Employer.
At Will Acknowledgment
If I am hired, I acknowledge that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the right to terminate my employment at any time, with or without prior notice, for any reason not prohibited by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration.
I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s Administrator/Director or Bethany’s Chief Executive Officer.
DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTOOD THE ENTIRE APPLICATION STATEMENT.
I certify that I have read, fully understand and accept all terms of the forgoing Application Statement.
