ATTESTATION:
Applicant certifies that there are no charges involving violation of pharmacy, or narcotic laws pending against me, nor have any such charges ever been made against me other than listed above. Applicant further certifies there has never been a conviction of a felony offense relating to controlled substances or at any time had an application for DEA registration denied, revoked, or a DEA registration surrendered for "cause" as defined under Federal Regulations.
Pre-employment drug testing policy : In the interest of safety and to promote a safe and productive work environment, certain assignments with ABBACARE HOME HEALTH SERVICES, LLC may require you to conduct a pre-employment drug test, where applicable.
I certify that the information in this application is true and complete for all practical purposes. It may be
verified by the Agency or any affiliate. Should a position be offered and later it is found that the
information is significantly untrue, incomplete, or misrepresented, I understand and agree that the
Agency or its affiliates are relieved of all commitments, financial or otherwise pertinent to employment,
and that I am subject to immediate discharge without recourse.
I understand and agree that if I am offered employment by the Agency, my employment will be for no
definite term and that either I, or the Agency will have the right to terminate the employment
relationship at any time, with or without cause, and with or without notice. I also understand that this
status can only be altered by a written contract of employment which is specific as to all material terms
and is signed by me and the Administrator of the Agency.
I understand, if I have direct patient contact that the Agency will perform a background check, including
criminal history check, OIG exclusion list check (if applicable), and any additional checks as required
by accrediting body standards or State Regulations. I further understand, if I am an unlicensed person,
the Agency will perform a check of the Nurse Aide Registry and Employee Misconduct Registry.
I understand that: 1) the purpose of the Employee Misconduct Registry is to ensure that unlicensed
personnel who commit acts of abuse, neglect, exploitation, misappropriation, or misconduct against
residents and consumers are denied employment in HHS-regulated facilities and agencies; 2) the State of
Texas maintains a registry of all nurse aides who are certified to provide services in nursing facilities and
skilled nursing facilities licensed by the Texas Health and Human Services (HHS) and they review and
investigate allegations of abuse, neglect, or misappropriation of resident property by nurse aides and if
there's a finding of an alleged act of abuse, neglect, or misappropriation, the nurse aide may request both
an informal reconsideration and a formal hearing before the finding is placed on the registry; 3) All
HHS-regulated facilities and agencies are required to check the Employee Misconduct Registry and
Nurse Aide Registry before hire to determine if I am listed in either registry as having committed an act
of abuse, neglect, exploitation, misappropriation, or misconduct against a resident or consumer and am,
therefore, unemployable. I understand that a refusal to authorize the criminal background check may
result in adverse employment action, such as rejection of the application or termination of employment.
Release: I hereby authorize any prior employers to provide such information concerning my employment
with them as may be requested, and also authorize the Registrar/Placement Office of all
educational institutions attended to release an official copy of my transcript and, if available,
faculty appraisals. I also authorize any appropriate licensing board to release full information
concerning my license status and my license history.