Authorization and Personal Consent to Perform Background Authorization:
I acknowledge that the Center is an At-Will employer and I understand that I am free to resign at any time, with or without cause and without prior notice, and the Center reserves the same right to terminate my employment or placement at any time, with or without cause and without prior notice, except as required by law. Any signed contractual agreement will supersede the at-will clause contained herein. I hereby authorize the Center to investigate my past and current employment, education, criminal history, including but not limited to clearinghouse databases to include Employee Misconduct Registry, the Nurse Aide Registry, Public Records, Professional Registries, Motor Vehicle Reports and the Department of Public Safety. If I am denied employment or placement, either wholly or partly, because of the information contained in a background report, a disclosure will be made to me of the information that affected the adverse placement or employment decision. I understand that I may be required to submit to a pre-employment/placement drug test that screens for illegal drugs and controlled substances. I further understand I must remain free of illegal drugs, alcohol and abusive levels of prescription drugs at work and agree to testing pursuant to Metrocare Policy (e.g. reasonable suspicion, workplace accident, etc.) I understand failure to comply may result in disciplinary action up to immediate termination of the relationship with the Center. I understand that records obtained through the Department of Public Safety's Computerized Criminal History (CCH) source are based on name and date of birth identifiers. Because the name-based information is not an exact search and only fingerprint record searches represent true identification to criminal history, the Center is not allowed to discuss any criminal information obtained based on the name and DOB search. I will be required to submit a full and complete set of my fingerprints for analysis through the Texas Department of Public Safety AFIS (Automated Fingerprint Identification System). The Center’s Human Resources department will contact me with the details of how to arrange fingerprinting. (Due to chain-of-custody requirements the Center cannot accept fingerprinting results that are outside the sanctioned Human Resources process.) I hereby authorize former employers and other persons with knowledge of my background, education or experience to release any and all information to the Center or its designee. I understand any information collected during such investigation will be confidential and I will not be given access to the information unless required by law and when a written request is made to Human Resources.
Certification and Signature:
I certify that the statements in this application are true and complete. I understand any false statement may be sufficient ground for my application to be rejected; or if currently employed I may be discharged from the Center. This form may be required on all individuals named as a party to a contract with the Center or the proprietor (or official) of any business providing service on behalf of the Center. I understand that, as a condition of my request that the Center consider my application and possibly hire me, I must agree to the Center’s policy of dispute resolution, which I understand requires that all disputes between applicants or employees and the Center, its constituent member entities, and/or its officials and/or employees must be resolved solely by arbitration, in accordance with the Center’s Arbitration and Single-employee Resolution Procedure 5.12 Policy, a copy will be provided upon employment and that such policy further requires I waive any right to participate in any class or collective action, either as a representative or member and that, instead, I must resolve any dispute, as an applicant or employee, through a single-party arbitration under the specific terms and conditions set forth in the Center’s Arbitration and Single-employee Resolution Procedure 5.12 Policy. I hereby confirm acknowledgment of the Policy and agree to be bound by all of its terms, including but not limited to limitations on time and discovery, as well as the prohibition of any class or collective action waivers, in connection with the consideration of my application for employment and throughout my employment, including termination thereof, if I am hired. I UNDERSTAND THE INFORMATION I SUBMIT BELOW IS USED TO ESTABLISH MY IDENTITY. I SWEAR (OR AFFIRM) TO THE TRUTHFULNESS OF THE INFORMATION I PROVIDED; I HAVE READ THE APPLICATION IN ITS ENTIRETY. I GIVE THE CENTER CONSENT TO PERFORM NECESSARY CHECKS. AT MY DISCRETION, I MAY SUBMIT A HAND-WRITTEN, SIGNED AND DATED APPLICATION IN LIEU OF THIS ELECTRONIC FORM. HOWEVER, I MAY NOT OPT-OUT OF REQUIRED BACKGROUND CHECKS OR OTHER REQUIREMENTS STIPULATED BY THE CENTER.
