CERTIFICATION AND AUTHORIZATION
APPLICANT PLEASE READ CAREFULLY
I certify that the answers that appear on this application and the information provided in my resume are complete and true. I hereby authorize Lake Superior Life Care & Hospice and/or its agents to verify any or all of the information provided on this application and in my resume. In order to verify such information, I hereby authorize all persons, schools, companies and law enforcement agencies to release any records or any other information they may possess relating to my application for employment. I also release any individual, partnership or corporation which presently or formerly employed me, any school I attended, their officers, agents and employees and any law enforcement agency from any liability, claims or
damages for issuing such information in good faith and without malice.
Should I become an employee at Lake Superior Life Care & Hospice, I also release Lake Superior Life Care & Hospice from any liability, claims, or damages for issuing such information in good faith and without malice to other individuals/institutions who have a legitimate and common interest in the subject matter.
I realize that falsification or omission of any information on this application, in my resume, or during any interview, will be grounds for rejection of my application or if I am offered employment, discharge at any time during my employment. I also understand that nothing in the
application is intended to imply or create an employment relationship or contract for employment.
If offered employment, I will submit to any medical examinations and drug tests deemed necessary by Lake Superior Life Care & Hospice to evaluate my physical and mental fitness for employment. If employed, I will submit to any physical or mental examination or drug testing deemed
necessary by Lake Superior Life Care & Hospice to determine my continued fitness to perform the duties of the job, or whenever such medical examinations are required by state or federal law. If employed, I agree to observe at all times all rules and regulations.
I acknowledge and agree that should I, once employed or as an employee, be subsequently arrested or convicted of one or more criminal offenses as listed below:
- Attempt or conspiracy to commit a felony;
- Misdemeanor, involving abuse, neglect, assault, battery or criminal sexual conduct involving fraud or theft against a vulnerable adult as defined in Section 145m of the Michigan Penal Code
I also agree to notify this employer in writing within twenty-four (24) hours of the criminal event.
I authorize Lake Superior Life Care & Hospice to conduct a thorough investigation of my past employment, background, criminal history, education, and activities. I agree to cooperate in such investigation and release and discharge from all liability, responsibilities, claims or damages of any kind or nature Lake Superior Life Care & Hospice and any other persons or entities requesting or supplying information pursuant to such investigation. I
understand that, if I am offered employment, my employment will be contingent upon me successfully passing, in Lake Superior Life Care & Hospice’s discretion, any investigation conducted by Lake Superior Life Care & Hospice. I further authorize Lake Superior Life Care & Hospice to supply my employment record, in whole or in part, to any prospective employer, government agency, or other party with a legal or proper interest.