APPLICANT’S STATEMENT
I certify that answers given in this document are true and complete to the best of my knowledge. I authorize the investigation of all statements contained in this application and if I am an excluded individual as per PA Dept. of Public Welfare’s MA Bulletin 99-11-05, I understand that any misrepresentation of fact contained herein may be grounds for invalidating any commitments resulting from this application.
I understand that it is the policy of ADAS to comply with all federal and/or state laws regarding Equal Employment as they relate to all employees and applicants for employment.
I understand that if I am a recovering substance user that I must be in recovery for at least two (2) years. This policy is not to discriminate, but because of the nature of the work, it is felt that two years is sufficient time to be able to perform job duties effectively.
I understand that If I am employed by ADAS I will be required to provide proper credentials (including transcripts), proof of identity and legal authority to work in the United States and that federal immigration laws required me to complete an I-9 Form in this regard. Furthermore, I understand if I am employed I must provide the employer with successful completion of a FBI background check, PA State Police Criminal background check, Dept. of Motor Vehicle records, Act 33 Child Abuse Clearance, and urinalysis.
I understand that this application remains current for one (1) year. At the conclusion of time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
APPLICANT’S AUTHORIZATION FOR INFORMATION TO BE SOUGHT OR OBTAINED
I consent to and authorize Alcohol & Drug Abuse Services, Inc. (ADAS) and its agents and employees, to obtain in any manner any reference information concerning me, including achievement, wage history, performance, attendance, personal history, disciplinary information and reason for separation of employment, relating to my employment with any former employer. It is expressly understand that any information sought or obtain is to be used for the purpose of determining my acceptability for employment. I also hereby release ADAS, its agents and employees, from all liability for damages or claims, including but not limited to defamation, interference with contract, or perspective economic advantage and negligence, I have or may have which arise or result from any reference information sought or obtained pursuant to his authorization.
APPLICANT’S AUTHORIZATION FOR THE RELEASE OF INFORMATION
I consent to and authorize the above named former employer, and its agents and employees, to furnish any reference information concerning me, including achievement, wage history, performance, attendance, personal history, disciplinary information and reason for separation of employment, relating to my employment with the former employer. It is expressly understood that any information given is to be used for the purpose of determining my acceptability for employment. I also hereby release the above named former employer, and its agents and employees, from all liability for damages or claims including but not limited to defamation, interference with contract, or perspective economic advantage and negligence, I have or may have which arise or result from any reference information provided pursuant to this authorization or any attempts to comply with this authorization.