(Please list names and how you are related to each one. If none, please indicate N/A.)
(Please list names and how you are related to each one. If none, please indicate N/A.)
If none, please type N/A.
(exclude activities relating to race, religion, national origin, gender, age, or disability)
If none, please type N/A. (exclude activities relating to race, religion, national origin, gender, age, or disability)
Acknowledgment - Read Carefully
By submitting my application online to Community Healthcare Center, I certify that the facts set forth in my application and any resume I have submitted are true and correct. I understand that any false statements, misrepresentation, or omissions on this application, my resume, or any other Center document shall be considered a sufficient basis for rejection of my application and for my dismissal if hired, regardless of when discovered. In the event of my employment with the Center, I agree to conform to the rules and the regulations of the Center at any time and acknowledge that these rules and regulations may be changed, interpreted, withdrawn, or added to by the Center at any time, at the Center.s option and without prior notice to me. I understand that this application will be given every consideration, but its receipt does not imply that I will be employed. I also understand that if I am employed, my employment will be at-will, meaning that employment may be terminated by me or the company for any or no reason, with or without cause, at any time. I further understand that nothing in this application is to be considered in any way as a contract for employment. I acknowledge and agree that any statement or representation, whether written or oral, past or present, which is contrary to my right and the Center.s right to an at-will employment relationship is void and unenforceable and should not be relied upon in the absence of a written contract of employment signed by the Executive Director.
I hereby authorize the Center to conduct any investigation it deems necessary regarding my application. I also hereby authorize the Center to gather and to release information about me, together with their opinion on these matters, without any liability for any damage whatsoever caused either directly or indirectly by giving or receiving such information or opinions. I authorize any former employer, present employer, schools, colleges, and universities, personal references and/or any other person or persons, to disclose to the company any information or opinions they may have concerning me, my character, or my employment record. I hereby unconditionally release the Center, any former employers, their agents and employees, and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure, including liability arising from negligence.
I understand that the Center may, in the course of its investigation of my application, obtain an investigative consumer report on me, as defined in the Fair Credit Reporting Act, and I understand that
such a report may include information as to my character, general reputation, personal characteristics, working skills and abilities, and mode of living. I understand that the Center is required to furnish to me upon proper request and within reasonable time, according to the law, the nature and scope of the investigation.