I hereby authorize Hope Care Center to conduct a criminal record background check for any criminal charges or convictions as well as a background check for exclusion from any Federal or state funded programs should I be extended an offer of employment (or opportunity to volunteer).  I further authorize any Federal, state, or local agencies to release this information to Hope Care Center.  I understand that any offer of employment (or opportunity to volunteer) is contingent upon receiving satisfactory responses to these background checks.

Hope Care Center promotes a drug-free workplace in order to provide the highest quality care to our residents. Therefore, Hope Care Center requires pre-placement drug and alcohol screening of any applicant extended a conditional offer of employment in order to detect the presence of illegal drugs and/or alcohol.  An applicant extended a conditional offer of employment must sign a cons4ent form that allows Hope Care Center to perform a drug and/or alcohol screening and submit the results to Hope Care Center.  Should an applicant refuse to sign a consent form or if the collection process is not completed within forty-eight (48) hours of notification, the employment offer will be withdrawn.

All drug and alcohol tests are subject to careful screening procedures. Positive test results are confirmed befre the results are communicated to you by Hope Care Center.  The conditional offer of empolyment will be withdrawn, thereby resulting in termination of employment, in the event of a confirmed positive test result.

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I acknowledge that I have read and understand the above Hope Care Center "New Employee Pre-Placement Drug Screen" Policy.  I have had the opportunity to ask questions reqgarding the policy's content.  I further understand that employment by Hope Care Center is contingent upon the drug screen exam.

I voluntarily consent to provide urine or other necessary speciment if I am extended a conditional offer of employment and further, I consent to having the specimen collected and tested by any laboratory that Hope Care Center may select.

I understnad that the results of these tests may be used for employment reason, and I authorize the releaese of this information to Hope Care Center from the selected laboratory.