HRA Employment Application

OVERVIEW Helping Restore Ability ("the Company") conducts criminal nistory/background checks, for lawful employment purposes, on final employment candidates, volunteers, independent contractors, and Board of Director applicants. This information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports" These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company in an employee, volunteer, independent contractor, or Board of Director capacity annually during your time of service The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal history and background, e.g., State of Texas Criminal History, Nurse Aid Registry, Employee Misconduct Registry, Office of the Inspector General (OIG); public court records; driving records; accident history; worker's compensation claims: bankruptcy filings: educational history verifications (e g. dates of attendance, degrees obtained); employment history verifications (es. dates of employment, salary information, reasons for termination, etc; personal and professional references checks: professional licensing and certification checks: drug/alcohol testing results, and drug/akchol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. Criminal history records are reviewed as they relate to the content and nature of the position for which the applicant is seeking A conviction/criminal history record does not necessarily disqualify an individual for employment or to be a volunteer, except for Convictions that are Automatic Bars to Employment as defined in Chapter 250.006 of the Texas Health and Safety Code. These records may not be released except by court order or written consent of the person being investigated Background information may be obtained from private and public record sources, including, as appropriate:government agencies and courthouses; educational institutions; former employers; personal interviews with sources such as neighbors, friends and associates; and other information sources If the Company should obtain information bearing on your credit worthiness, credit standing or credit capacity for reasons other than as required by law, then the Company will use such credit information to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being evaluated You may request more information about the nature and scope of any investigative consumer reports by contacting the Company Criminal background checks obtained through a consumer reporting agency are subject to the Fair Credit Reporting Act (FCRA) A summary of your rights under the Fair Credit Reporting Act is being provided to you. You may request more information about the nature and scope of any investigative consumer reports by contacting the Company

Authorization to Obtain Criminal History/ Background Information: The information requested below is used to obtain accurate criminal history/background information It serves as a unique identifier in the event that names are similar to yours. The information requested below will not be used to determine eligibility for employment or for the position that you are seeking. Supplying information that identifies your age, gender and race is optional at this time, but it will be required if you are offered a position at Helping Restore Ability. It may also be issued for U.S. government statistical purposes.

By execution of this document, I acknowledge that I have been informed by the Agency and agree that the Agency may conduct a State of Texas criminal history check per TXH&SC 250.006. I agree to a search of the Nurse Aide Registry and the Employee Misconduct Registry prior to employment and at least every 12 months if hired. As required, I agree to a search of the Texas Health and Human Services Commission’s OIG List of Excluded Individual/Entities and the HHS - OIG Excluded Individuals/Entities Search Database prior to being hired and monthly thereafter. I understand that these checks will determine if I have a criminal conviction or have committed certain conduct that will bar me from employment with this Agency. I understand that I am unemployable if listed as unemployable in the NAR or EMR per TAC §93.3 and TxH&SC Chapter 253.

CRIMINAL HISTORY CHECK
I have informed this agency of all names (i.e., maiden, aliases) that I have used in the past. I understand that my employment is pending the results of the criminal history check and that I may not have face-to-face patient/client contact until results are returned. I will be notified of results.

CONVICTIONS BARRING EMPLOYMENT.
(A) A person for whom the facility is entitled to obtain criminal history record information may not be employed in a facility if the person has been convicted of an offense listed in this subsection:

· An offense under Chapter 19, Penal Code (criminal homicide);
· An offense under Chapter 20, Penal Code (kidnaping, unlawful restraint, and
smuggling of persons);

· An offense under Section 21.02, Penal Code (continuous sexual abuse of a
young child or children) or Section 21.11, Penal Code (indecency with achild);

· An offense under Section 22.011, Penal Code (sexual assault);
· An offense under Section 22.02, Penal Code (aggravated assault);
· An offense under Section 22.04, Penal Code (injury to a child, elderly individual,
or disabled individual);

· An offense under Section 22.041, Penal Code (abandoning or endangering a child);
· An offense under Section 22.08, Penal Code (aiding suicide);
· An offense under Section 25.031, Penal Code (agreement to abduct from custody);

· An offense under Section 25.08,
· An offense under Section 28.02,
· An offense under Section 29.02,
· An offense under Section 29.03,
· An offense under Section 21.08,
· An offense under Section 21.12,
between educator and student);

· An offense under Section 21.15,
recording);

· An offense under Section 22.05,
· An offense under Section 22.021, Penal Code (aggravated sexual assault);
· An offense under Section 22.07, Penal Code (terroristic threat);
· An offense under Section 32.53 Penal Code (exploitation of a child, elderly
individual, or disabled individual);

· An offense under Section 33.021, Penal Code (online solicitation of a minor);
· An offense under Section 34.02, Penal Code (money laundering); Penal Code (sale or purchase of a child); Penal Code (arson); Penal Code (robbery); Penal Code (aggravated robbery); Penal Code (indecent exposure); Penal Code (improper relationship); Penal Code (improper photography or visual); Penal Code (deadly conduct);
· An offense under Section 35A.02, Penal Code (Medicaid fraud);

· An offense under Section 36.06, Penal Code (obstruction or retaliation);

· An offense under Section 42.09, Penal Code (cruelty to livestock animals), or under Section 42.092, Penal Code (cruelty to nonlivestock animals); or

· A conviction under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing elements that are substantially similar to the elements of an offense listed by this subsection.

· An offense the Agency determines to be contraindicated to employment with the consumers the Agency serves.

(B) A person may not be employed in a position the duties of which involve direct contact with a patient/client in a facility or may not be employed by an individual employer before the fifth anniversary of the date the person is convicted of:

· An offense under Section 22.01, Penal Code (assault), that is punishable as a ClassA misdemeanor or as a felony);

· An offense under Section 30.02, Penal Code (burglary);

· An offense under Chapter 31, Penal Code (theft) that is punishable as a felony);

· An offense under Section 32.45, Penal Code (misapplication of fiduciary property or property of a financial institution), that is punishable as a Class A misdemeanor or a felony; or

· An offense under Section 32.46, Penal Code (securing execution of a document by deception) that is punishable as a Class A misdemeanor or a felony. An offense under Section 37.12, Penal Code (false identification as a peace officer; misrepresentation of property); or

· An offense under Section 42.01 (a) (7), (8), or (9), Penal Code (disorderly conduct).

(C) In addition to the prohibitions on employment prescribed by Subsections (A) and (B), a person for whom a facility licensed under Chapter 242 or 247 is entitled to obtain criminal history record information may not be employed in a facility licensed under Chapter 242 or 247 if the person has been convicted:

· Of an offense under Section 30.02, Penal Code (burglary); or

· Under the laws of another state, federal law, or the Uniform Code of Military

(D) Justice for an offense containing elements that are substantially similar to the elements of an offense under Section 30.02, Penal Code. For purposes of this section, a person who is placed on deferred adjudication community supervision for an offense listed in this section, successfully completes the period of deferred adjudication community supervision, and receives a dismissal and discharge in accordance with, Article 42A.111 Code of Criminal Procedure, is not considered convicted of the offense for which the person received deferred adjudication community supervision. 

The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every “consumer reporting agency” (CRA). Most CRAs are credit bureaus that gather and sell information about you such as if you pay your bills on time or have filed bankruptcy – to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1781-1681u, at the Federal Trade Commission’s website (http;//www.ftc.gov). The FCRA gives you specific rights, as outlines below. You may have additional rights under the state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.
You must be told information if your file has been used against you. Anyone who uses information from a CRA to take action against you – such as denying an application for credit, insurance, or employment – must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.
You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You are also entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise a CRA may charge you up to eight dollars.
You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs-- to which it has provided the data--of any error.) The CRA must give you a written report of the investigation and a copy of your report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.
Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies itsaccuracy
5. You can dispute inaccurate items with the source of the information. If you tell anyone-- such as a creditor who reports tothe CRA--that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you have notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.

6. Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old, ten years for bankruptcies.

7. Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA--usually to consider an application with a creditor, insurer, employer, landlord, or other business.

8. Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA maynot report medical information about you to creditors, insurers, or employers without your permission.

9. You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed fromfuture lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.

10. You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court. The FCRA gives several different federal agencies authority to enforce the FCRA: