CERTIFICATION AND AGREEMENT
Please Read Carefully
Should you be called for an interview, you will be asked to sign this “Certification and Agreement”.
In consideration of being employed, I understand and agree that:
1. If I misrepresent or deliberately leave out a fact in my application, I may be refused employment or, if employed, I may be terminated.
2. I understand that prior to employment, I will be required to submit to a criminal history background check.
3. If employed, I may terminate my employment at any time without notice or cause, and the employer may terminate or modify the employment relationship at any time without prior notice or cause. In consideration of my employment, I agree to conform to the rules and regulations of the employer, and I understand that no department head or representative of the employer, other than the President of the Company, has any authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any agreement or assurances contrary to this policy.
4. The needs of the employer may make the following conditions mandatory: overtime, shift work, rotating work schedule, or a work schedule other than Monday through Friday. I accept these conditions of employment.
5. The employer is an equal opportunity employer. The employer does not discriminate in employment and no question on my employment application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.
6. If implied, I understand that my employment is for no definite period of time, and if terminated, the employer is liable only for wages earned as of the date of termination.
7. I understand that the employer requires all staff to report sanction, convictions, suspensions, censures or revocation (“sanction”) action taken against them by federal, state, local, or other professional entities. These sanctions may include but are not limited to infractions against professional licensure, criminal history convictions, history of child abuse, managed care organizations, etc..
8. This application is current and active for only six months. At the conclusion of this time, if I have not had any contact from the employer and still wish to be considered for employment, it will be necessary for me to fill out a new application.
Typing your name into this field acts as an electronic signature. By signing you are stating that the information included in this application is true and accurate to the best of your knowledge. The parties agree that the electronic signatures appearing in this application are the same as handwritten signatures for the purposed of validity, enforceability, and admissibility.
