The job description for the job/position for which I am applying has been given to me or explained sufficiently. I understand the qualifications and essential functions of this job/position. I also understand all of the requirements that are necessary to perform this job/position in a safe and satisfactory manner.

Education
High School

Give name, address and telephone number of three-character references who are not related to you and are not previous employers.

If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any accident or violation during the past 36 months.

I understand the importance of safe driving, and that the well being of the individuals served is the primary concern. Safe driving is an absolute must for employment. I understand that this report will be used for employment purposes and that if my driving record disqualifies me as a permissible driver, I may not be employed. I further understand that if my driving record deteriorates after employment, I may become disqualified as a permissible driver, and my employment status may have to be re-evaluated at that time.

I hereby verify the information provided by me in this Application for Employment and any supplemental information is correct and complete to the best of my knowledge. I understand that any misstatement or omission of fact on this application and supplemental information may result in my not being hired, or if employed, my termination. I authorize investigation of all statements contained in or with this application.

I authorize LifeWorks to obtain any information through personal interviews with my neighbors, friends and acquaintances. This report, if obtained, may include information as to my character, general reputation, and personal characteristics. I further authorize investigation through law enforcement, any and all state agencies, any and all federal agencies, employers or any other appropriate firms. I understand I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of any such investigative report that is made.

If hired, I agree to maintain the confidentiality of all consumer information obtained either verbally or in writing. I may discuss this information with LifeWorks Community Services personnel on a need-to-know basis, and with others only as permitted by law. I understand failure to maintain confidentiality will result in disciplinary action, up to and including termination.

I understand that additional information may be required of me. I certify that all entries on this application and information with it are correct and completed to the best of my knowledge.

All qualified applicants will receive consideration for employment without regard to race, creed, color, sex, national origin, religion, age, or disability.

Applicant's Authorization

I consent to and authorize the above named employer, and its agents and employees, to furnish any reference information concerning me, including achievement, performance, attendance, personal history, disciplinary information and reason for separation of employment, relating to my employment with the employer. It is expressly understood that any information given is to be used for the purpose of determining my acceptability for employment. I also hereby release the above named employer, and its agents and employees, from all liability for damages or claims, including but not limited to defamation, interference with contract, or prospective economic advantage and negligence, I have or may have which arise or result from any reference information provided pursuant to this authorization or any attempts to comply with this information.