List three professional references who have knowledge of your qualifications. These should not be family nor personal friends.
Please read carefully before signingI understand and agree that:The information on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification of refusal of employment, or if employed, termination from The Arc of the Piedmont’s employ.Any offer of employment I may receive from The Arc of the Piedmont is contingent upon my successful completion of the agency’s total pre-employment screening process, including the agency’s receiving reference that it considers satisfactory, and my satisfactory completion of any post offer pre-employment medical examination that the agency may require. I also agree, if employed, to submit to a medical examination at any time at the agency’s request. I further agree, if employed, to submit to any training and testing required by the Department of Behavioral Health & Developmental Services as part of the agency’s licensing requirements. I hereby consent to having the results of any post-offer pre-employment or post-employment examination or testing I may be required to take disclosed to the Department of Behavioral Health & Developmental Services as part of the agency’s licensing requirements.I understand that as a condition of employment, I may be required to undergo and successfully pass a screening for alcohol and/or drugs. I also understand and agree that, if employed, I may be required to submit to an alcohol or drug screening at any time at the discretion of the Executive Director. I hereby consent to having the results of any such alcohol or drug screening I may be required to undergo disclosed to the Executive Director or his/her designee.I authorize and request that all of my present and former employers and those individuals I have listed as personal references furnish information about my employment record, including a statement of the reason for termination of my employment, work performance abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information.In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of the agency and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either the company or myself. I further understand that no manager or representative of the agency, other than the Executive Director or Board President, has any authority to enter into any agreement with my for employment for any specified period of time or to make any agreement different from or contract to the foregoing. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and the Executive Director or Board President.
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