Please list three (3) professional and/or personal references.
List current or most recent employer first, including U.S. Military Service.
*PLEASE READ CAREFULLY BEFORE SIGNING*
I hereby certify that all of the information provided by me in this application (or any accompanying documents) is
correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation
or omission of any facts in said documents may be cause for denial of employment or immediate termination of
employment regardless of the timing or circumstances of discovery.
I understand that submission of an application does not guarantee employment. I further understand that if
employed, my employment with The House of the Good Shepherd (hereinafter referred to as "HGS") is at-will and
for no specified duration and may be terminated by either HGS or myself at any time, with or without cause or
notice. I understand that none of the documents, policies, procedures, actions or statements of HGS representatives
used during the employment process alter the at-will nature of my employment in any way or is deemed a contract
of employment, real or implied.
If employment with HGS is obtained under this application, I agree to conform to the rules, regulations, policies
and procedures of HGS, which I understand are subject to change from time to time by the Agency, at all times
and understand that such compliance is a condition of employment. I understand that due to the nature of HGS
business, attendance and punctuality are considered essential requirements of every employee of HGS and that
poor attendance or tardiness will result in disciplinary action.
I understand that placement into any position offered is conditioned upon the Agency's receipt of a satisfactory
background investigation. The investigation will include verification of employment history and education, and,
where appropriate, may also include but not be limited to investigation of criminal record, driving record, status with
the State Central Register for the Abuse and Maltreatment of Children and professional references. I understand
that any offer of employment is contingent upon my passing a drug test conducted at a site designated by HGS,
and that failure to submit to or pass the drug test will rescind the offer of employment in accordance with the
Agency's Drug Free Workplace Policy. Additionally, I understand that placement will be conditioned upon satisfactory
completion of a job-related physical examination.
I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to
HGS and/or any of its representatives, and I release all parties involved from any and all liability for any and all damage that may result from providing such information.
I understand that this application is considered current for one year. If I wish to be considered for employment after this period I must fill out and submit a new application.
It is the policy of The House of the Good Shepherd to hire, place, transfer and promote employees without regard to race, color, sex, national origin, religion, age,
veteran status, non-job-related condition, disability, sexual orientation or any other legally protected status.