Authorization
Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment.
I hereby certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC is an equal opportunity employer and will consider applicants for all positions without regard to race, age, color, religion, marital status, national origin, disability, veteran status or any other legally protected status.
No applicant will be rejected as a result of an impairment that, with reasonable accommodation, does not prevent performance of the work.
GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC will not tolerate sexual harassment or harassment on the basis of any protected class status in the workplace.
I understand that, if selected I will be required to provide proof of my identity and legal right to work in the United States prior to actual employment at GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC.
I certify that I have answered truthfully and have not knowingly withheld information relative to my application. I understand that any misrepresentation or material omission on the application will result in my being eliminated from further consideration. I further understand that, if accepted for employment, any misrepresentation or material omission that becomes known to GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC may result in immediate termination of my employment.
I hereby authorize all previous employers and supervisors, including all persons with and for whom I have worked to give GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC any and all information regarding me and my previous employment. I release GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC and all previous employers and supervisors from liability for any damages that may result from furnishing information to GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC.
In consideration for my employment, I agree to adhere to all existing and future instruction, rules, and policies of GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC. I also understand that GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC reserves the right to change wages, hours and working conditions as deemed necessary and that no representative of GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.
I understand that all employees of GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC with respect to the length of employment, are considered to be "at will." This means that I may terminate my employment with GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC at any time without notice, without liability, for any extended period. Similarly, GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC may terminate my employment with GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC, at any time without notice, without liability, for any extended period. There is no guaranteed length of employment for any employees. Any representation by any agent or employee of GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC to the contrary is not authorized or binding upon GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC unless in writing and signed by the President of GENESIS ALLIANCE FOR MENTAL WELLNESS, LLC.
Consent for Pre-Employment Reference and Background Check:
I recognize that my offer of employment to me by Genesis Alliance for Mental Wellness, LLC is contingent upon my successfully passing reference and background screening. I understand that Genesis Alliance for Mental Wellness, LLC shall conduct Pre-Employment Reference and Background Checks thoroughly and within all applicable state and federal laws.
In consideration of this agency's review of my application for employment, I hereby release any individual entity, and Genesis Alliance for Mental Wellness, LLC from all claims or liabilities that might arise from the inquiry into or disclosure of such information, including claims under any federal, state, or local civil right laws and any claims for defamation or invasion of privacy.
I hereby voluntarily consent to and authorize Genesis Alliance for Mental Wellness, LLC or its authorized representative bearing this release or copy thereof. In connection with my application for employment with Genesis Alliance for Mental Wellness, LLC to obtain a consumer report (no credit check will be performed) for employment purpose including:
Criminal History
Department of Motor Vehicle History
Certification and Licensing
Educational Credentials
Employment Eligibility (Social Security Number Check)
Employment Checks
Reference Checks
licensing boards
I authorize all persons who may have information relevant to this research to disclose such information to Genesis Alliance for Mental Wellness, LLC, or its agents and I hereby release all persons from liability on account of true and accurate disclosure. I hereby further authorize that a photocopy of this authorization to be considered as valid as the original. Should there be any questions as to the validity of this release, you may contact me as indicated below.
DRUG-FREE WORKPLACE:
As part of the employment agreement with Genesis Alliance for Mental Wellness, LLC, I certify to Genesis Alliance for Mental Wellness, LLC that a drug-free workplace will be provided by any employees during the performance of this Contract pursuant to paragraph 7 of subsection B of Code 50-24-3. I understand the contract may be terminated at any time is such code is violated.
I understand that Genesis Alliance for Mental Wellness, LLC may request a urinalysis test at any time. Failure to comply within 24 hours may result to termination of contract.
AUTHORIZATION FOR PRIOR EMPLOYER TO RELEASE INFORMATION:
I herby authorize my prior employer to release any and all information relating to my employment with them to Genesis Alliance for Mental Wellness, LLC. I further release and hold harmless both prior employer and Genesis Alliance for Mental Wellness, LLC from any and all liability that may potentially result from the release and/or use of such information. I understand that any information released by my prior employer will be held in the strictest confidence, that it will be viewed only by those involved in the hiring decision, and that neither I nor anyone else not so involved will have the right to see the information.
