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.
“I understand that if I have a protected disability that affects my ability to do the job I seek, I may ask Lake Superior Life Care & Hospice to attempt to make a reasonable accommodation for it. I must make my request in writing to the Human Resources Department as soon as possible, and under the Michigan Persons With Disabilities Civil Rights Act, the notice must be given no later than 182 days after the date I know or reasonably should know that accommodation is needed.