Read the following statement and check yes or no.
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
I hereby authorize the Employer to check my criminal record, and I request all law enforcement agencies to provide the employer with any information about any criminal convictions I may have, upon request by the Employer.
I agree to cooperate in urine, breath or other lawful testing for drugs or alcohol upon request by the Employer prior to or during my employment, and I hereby release the Employer and any testing clinic or laboratory retained by the employer from liability for any lawful conduct by any of them in connection with such testing.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
I certify that I have not been convicted of an offense that would preclude employment in a nursing facility and am not excluded from participating in Federal Healthcare programs.