Employment Application

I hereby certify that all statements made on this application are true and complete to the best of my knowledge and belief. Material misstatements or omissions and falsifications will be grounds for disqualification or termination of employment. Initials*

I understand that during the selection process, I may be required to complete a background data packet. I hereby authorize the North Central Florida Health Planning Council, Inc, dba. WellFlorida Council, Inc. and its agents; to investigate all statements contained in this application; and to conduct a thorough investigation of my character, reputation, past employment, and criminal record. Initials*   

I acknowledge and I hereby waive any rights or claims I may have, whether presently fully developed or not, against the North Central Florida Health Planning Council, Inc, dba. WellFlorida Council, Inc. or its agents or employees arising out of or resulting from the release, authorized or unauthorized, of the information received pursuant to or in conjunction with the Council's handling, processing or investigation of my application for employment. Initials*   

I understand that the North Central Florida Health Planning Council, Inc, dba. WellFlorida Council, Inc. only hires U.S. citizens and lawfully authorized alien workers. Identification and proof of citizenship or authorization will be required if a conditional job offer is made.   Initials*   

I acknowledge that the North Central Florida Health Planning Council, Inc, dba. WellFlorida Council, Inc. has a insurance policy that requires a review of my driver license record in order to drive on the Council's behalf. I understand that if my driving record is not satisfactory, I will not be eligible for employment. Initials*