Reason for Applying (Please print ALL Information)
Please tell us why you want to work in this field and/or for this agency:
I understand that my employment is conditional upon my providing proof of identification and authorization to work in the United States. I hereby acknowledge notification that an inquiry may be made to procure information relating to my work experience, criminal history, character, general reputation and personal characteristics. I hereby acknowledge that the results of such inquiries will have a direct impact on any decision to hire, or on my continued employment with CMHS, Inc. In connection with any inquiry which might be made, I hereby authorize all schools, persons, companies, corporations, credit bureaus and agencies, public and private, who possess information about me and/or act as custodians of any records relating to me, to release to this company or any designated representative thereof, any and all information concerning my background and personal history and release them from any liability and responsibility which might result. I indemnify CMHS, Inc. from any liability, which might result from making such inquiry.
I understand that the facilities must be staffed 24-hours/7-days per week, in order to provide necessary services to clients. I understand that work schedules are designed to meet facilities’ needs and that I may be required to work shifts other than the one for which I am applying.
I acknowledge and understand that applicants will be given equal consideration regardless of race, gender, age, color, national origin, marital or veteran status, sexual orientation, religion or disability. No question on this application is intended to secure information concerning the aforementioned. Any offer of employment may be conditioned upon the result of medical examination requested by the Employer and conducted solely for the purpose of determining whether an individual, with reasonable accommodation, is capable of performing the functions of the job.
This application will be given every consideration, but its receipt does not imply that employment will be offered. I understand further that any misrepresentation or omission of facts is sufficient cause for cancellation of this application or separation from the company if I am employed.
Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between CMHS, Inc. and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me. I understand that no manager or representative, other than the Chief Executive Officer, has any authority to enter into any agreement for employment for any specified period of time; and that any agreement with the CEO must be in writing and signed. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and CMHS, Inc. retains a similar right.
I hereby acknowledge that I have read the foregoing disclosures and understand them.