Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, disability, veteran status, or any other characteristic protected under local, state or federal law.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

For Certified Peer Specialist Candidates ONLY: Can you self-identified with a serious mental health illness or serious emotional disturbance: A condition experienced by persons 18 years of age and older who, at any time during the past year, had a diagnosable mental, behavioral, or emotional disorder that met the diagnostic criteria within the current DSM and that has resulted in functional impairment and which substantially interferes with or limits one or more major life activities. Adults who would have met functional impairment criteria during the referenced year without the benefit of treatment or other support services are considered to have serious mental illness. Substance use disorders and developmental disorders are not included.

***IF YES PLEASE PROVIDE A COPY OF YOUR CERTIFICATE***

Please list your complete employment history with Specific Dates. List present or most recent employer first. Use an additional page, if necessary. (CPS applicants must show 12 months of work or volunteer experience over the past 3 years)

Note: you will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform and Control Act and your employment is contingent upon furnishing such documents.

** Do not complete the question below if you reside in Philadelphia or Pittsburgh ** **Have you ever been convicted of a crime (felony or misdemeanor)?**

If you answer yes, then on an attached separate sheet of paper, please provide the details of your exclusion (date of exclusion, reason, duration, whether the exclusion has been lifted, date lifted, and copy of documentation proving that you are no longer excluded.

Warning: You cannot be employed by Peerstar LLC if you are excluded from participation in these programs. Your continued non-exclusion from these programs is an ongoing condition of employment with Peerstar.

If you are not presently excluded from these programs and you later receive notice or have reason to believe that you are or have been excluded, you agree as a condition of employment to notify Peerstar LLC of this fact immediately.

I certify that the answers given by me to the foregoing questions and statements are true and correct to the best of my knowledge without consequential omissions of any kind. I agree that the Company shall not be held liable in any respect if my employment is rejected or subsequently terminated because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may lead to employment termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular pre employment physical. I also voluntarily and knowingly authorize the companies, schools or persons named above to give any information requested regarding my former employment, character and qualifications. I hereby voluntarily and knowingly fully release and discharge, absolve, indemnify, and hold harmless said companies, schools or persons from any and all liability for any damages for issuing this information, except for the malicious and willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from obtaining employment, which the party disclosing such facts knows to be untrue. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause and with or without notice, at any time, at the option of either my employer or myself.