Rehabilitative Therapy Division Applicant Consent Release
Caution to the applicant! Please read carefully!
I understand that prior to the start of employment with Easterseals South Carolina, that Easterseals South Carolina will order a South Carolina Department of Social Services(SCDSS) Central Registry of Child Abuse and Neglect Database Check, an American Databank Nationwide Criminal Search, a Social Security Number Trace, a Social Security Number Validation, a South Carolina Law Enforcement Division (SLED) Criminal Records background check, a Centers for Medicare and Medicaid Services (CMS) List of Excluded Individuals/Entities (LEIE) Check, and a National Sex Offender Registry search. If any of the reports reveal any negative history, employment will not be offered. Please do not continue this Employment Application process if any of the checks listed in this section will reveal a negative history.
I understand that prior the start of employment with Easterseals South Carolina, that Easterseals South Carolina will order a South Carolina Department of Motor Vehicle (SCDMV) Request for Driver Information Report, as required by Easterseals South Carolina’s liability insurance carrier. If an applicant has an out of state driver’s license, a DMV driver report will be ordered from the state the license is held in. If the DMV Request for Driver Report indicates more than two (2) moving violations or at-fault accidents within the three (3) years immediately preceding, license suspension, or driving without insurance then employment will not be offered.
I understand a copy of my active automobile insurance card with my name listed as an insured driver is required and will be updated annually. Employment will not be extended without receipt of the automobile documents.
I understand that if I am employed by Easterseals South Carolina, that all Federal and State Background Checks listed above will be checked throughout employment with Easterseals South Carolina. If at any time, my Federal or State Background Checks reveal a negative history, employment with Easterseals South Carolina may be terminated.
I understand that the items mentioned above are absolute requirements, and Easterseals South Carolina’s use of and reliance on these items is not negotiable. If you anticipate that one or more of these items will present a problem, then please address your concerns with the Easterseals South Carolina’s Director of Human Resources prior to submitting your completed application.
By my signature, I consent to the release of information to authorized officers, agents, and employees of the State of South Carolina and Easterseals South Carolina, which may include, but not be limited to information concerning my past and present work; including my official personnel files; attendance records, evaluations, education records including transcripts, military service, law enforcement records; and any personnel record deemed necessary. In addition, I consent to authorize appropriate officers, agents, and employees of the State to make inquiries of third parties. I further release the organization, educational entity, present and former employers, law enforcement organizations, and all third parties from any and all claim of whatever nature that I may have as a result of any inquiry or response given to such inquiries made in connection with my application for employment.
By my signature, I affirm, agree, and understand that all information on this form is true and accurate. Any misrepresentation, falsification, or material omission of information or data on the application may result in exclusion from further consideration or if hired, termination of employment. If I have requested herein that my present employer not be contacted, an offer of employment may be conditioned upon acceptable information and verification from such employer prior to beginning work.