I represent that the information provided in this employment application (and accompanying documents, if any) is true and complete. I understand that any false information or significant omissions may disqualify me from any further consideration for employment and may be justification for dismissal from employment of discovered at a later date. I agree to immediately notify the agency if I should be convicted of any crime while my job application is pending.
I authorize investigation of all statement contained in this application and authorized any individual or entity to provide information and opinion to the agency as part of the investigation. I authorize the agency to disclose information contained in this application along with any information about me obtained through investigation or during the course of the interview process. I release the agency and any individual, or entity providing information to the agency from any legal liability for any damages; from the disclosure of this information.
I understand that if accused of wrongdoing while employed, I may be subjected to probe by an outside agency.
I understand that if I am hired; my employment "at will" which means that it is for no definite period of time and may be terminated by me or the agency at any time for any reason.
I understand that if I am hired; the agency does not guarantee any specific number of hours or shifts. I understand and agree that I will not accept employment by any the agency client where I have been assigned by the agency for a period of six (6) months following termination of my employment with the agency
I understand that if I am hired, a client may decide not to utilize my services at any time and will inform the agency if this occurs. That decision is made solely by the client. I understand that disclosure of the reason(s) for any such decision is at the sole discretion of the client and that I am not privy to that information. I understand and acknowledge that if this occurs, I may not be assigned to other clients. In the event I have any concerns regarding my assignment to a client, I will immediately bring my concerns to the agency
I agree, if I am hired by the agency, to keep my credentials and JCAHO and OSHA in service requirements current, and to abide by the policies, procedures and supervision of the client to which I am assigned and those of the agency
Consumer notification for the agency
This is to inform you that a consumer report or an investigative consumer report may be obtained from a consumer agency for the purpose of evaluating you employment, assignment, promotion, reassignment, or retention as an employee. This report may contain information bearing on your credit worthiness, credit standing, credit capacity,
character, general reputation, personal characteristics, or mode of living form public record sources or through personal interviews with your neighbors, friends or associates. You may also have the right to request additional disclosures regarding the nature and scope of the investigation.
I certify that the information I have provided in this enrollment form is true and complete to the best of my knowledge, and I understand that one or more falsified statements within this application is grounds for rejection. I understand the content, terms and conditions and I was given the opportunity to ask questions. By signing this document, I certify that I agree and accept the information contained in this document.