List all prior or current employment first. 

CONFIDENTIAL

The following questions relate to our desire to care for and protect the children, youth, and vulnerable adults in our care. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy in every possible context. In accordance with our policy, suspicions or allegations of child abuse or neglect will be reported to relevant state authorities.

If you answered ‘yes’ to the question above, please answer the following questions:

*A conviction, pending charge, or pending case is not an automatic bar to employment. Mahoning Valley will consider, among other things, the nature of the offense, the nature of the job, the timing of the offense, and your activities and conduct since the offense occurred before making a final decision. All employment decisions will conform to applicable law.

PLEASE READ CAREFULLY BEFORE SIGNING

 

I authorize Mahoning Valley personnel to communicate with any prior employer or organization with whom I have volunteered in the past regarding work with children, minors, or vulnerable adults.

I authorize any reference or organization listed in this application and any past employer or volunteer supervisor to release any information in files or records concerning me. I authorize any reference, organization, or past employer to provide any information (including opinions) that they may have regarding my character, fitness for employment, and the wisdom of entrusting children or vulnerable adults to my care or supervision.

I release any individual, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or my family, on account of compliance or any attempt to comply with this authorization. This authorization includes explicit child protection information, opinions, or records explicitly.

I release and discharge Mahoning Valley and its agents and associates to the full extent permitted by law from any claims, damages, losses, liabilities, expenses, or any other charges or complaints filed with any agency arising from retrieving and reporting this information. I may invoke my right to inspect any information provided about me by any consumer reporting agency.

I understand and agree that if I am offered conditional employment, my appointment is for no definite period and may, regardless of the date or method of payment of my wages or salary, be terminated by either party at any time without previous notice or cause. It is also subject to changes in wages, conditions, benefits, and operating policies.

If employed, a potential employer may contact Mahoning Valley or its representatives in the future concerning my work record and work performance at Mahoning Valley. Specifically, I agree that Mahoning Valley may share information with any future potential employer if such information relates to inappropriate behavior with moral turpitude.

I authorize Mahoning Valley to divulge all information relevant to any potential future employer concerning my work and/or performance at Mahoning Valley. This consent specifically includes any information related to any allegation or investigation of child abuse, abuse of a vulnerable adult, sexual abuse, sexual assault or molestation in any form.

I agree to a medical examination or inquiry if requested, if I receive a conditional offer of employment, including the analysis for the detection of the use of illegal drugs or controlled substances. I understand that testing positive for illegal drugs or controlled substances could negate my employment or continued employment.

As a prospective employee of a ministry, I agree to conform to the highest standards of safety, interpersonal conduct and sexual morality. I affirm that I will strictly comply with ministry policies, including those concerning child protection, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies may result in my immediate dismissal.

I understand, as a condition of employment, I will be required to provide proof that I am legally eligible to work in the United States.

I understand in the course of the application process, I may become aware of Confidential Information related to the operations of the Ministry. I acknowledge that any disclosure or misappropriation of any Confidential Information may cause irreparable harm to the ministry.

I understand, as a condition of employment, I will be required to pass a Background Check.

I understand that adverse results of a Background Check, including ongoing Background Checks, could negate my employment or continued employment.

In consideration of the receipt and evaluation of this application, I release Mahoning Valley and its agents from any and all liability for any damage that may result from furnishing such information to Mahoning Valley. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application, or any past employer, except as may be required by law.

My responses above are true and correct. I understand and agree that any false answers or statements on this application, or any false statements made during the interview process, will be sufficient grounds for not hiring, or immediately discharging me, no matter when discovered.

I HAVE CAREFULLY READ AND AGREE TO THE FOREGOING. I UNDERSTAND AND AGREE THAT A COPY OF THIS APPLICATION WILL BE AS VALID AS THE ORIGINAL.