Build a Career in Behvioral Health

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.  

I authorize _________________ to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.  

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its _________________, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of _________________, except in a specific written contract of employment signed on behalf of the organization by its _________________, has the power to alter or vary the voluntary nature of the employment relationship.  

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.  

After carefully reading this background check disclosure and authorization form, I authorize the Company to order my background report, including investigative consumer reports.  I understand that the Company may rely on this authorization to order additional background reports, including investigative consumer reports, during my employment without asking me for my authorization again as allowed by law.  
 
I also authorize the following agencies and entities to disclose to the background check company and its agents all information about or concerning me, including but not limited to: my present employers, learning institutions, law enforcement and all other federal, state and local agencies; federal state and local courts; the military; credit bureaus; testing facilities; motor vehicle record agencies; if applicable, worker’s compensation injuries; all other public and private sector repositories of information; and any other person organization or agency with any information about or concerning me.  Worker’s compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or other applicable federal, state or local laws and only after a conditional job offer is made.  The information that can be disclosed to the background check company and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses and substance abuse testing.   

I agree that the Company can rely on this authorization to order background reports, including investigative consumer reports, from companies other than the background check company without asking me for my authorization again, as allowed by law.  I also agree that copy of this form is valid like the signed original.  I certify that all of the personal information I provided is true and correct.