SIGNATURE step 7 of 7
By signing below:
I declare that all information provided on my application to be a candidate
for Help At Home, Inc. or any information provided as attachment(s) to my
application are true, accurate, and can be verified if necessary.
I understand that any false statements or deliberate omissions on this
document may be grounds for disqualification from employment or, if discovered
after employment begins, could result in discipline up to and including my
termination of employment.
I hereby authorize Help At Home, LLC to verify information provided on the
employment application. Information subject to verification includes, but is not
limited to: Former employment: dates of employment, main responsibilities,
average of hours per week, supervising experience, quality of work performed, key
strengths and areas for improvement, communication skills, reason for leaving
organization and eligibility for rehire. Education, Licensure and Certification:
Existence on registry, degree, GPA, expiration date.
FOR TENNESSEE APPLICANTS ONLY I certify and affirm that to
the best of my knowledge and belief, I have not or have not had a case of abuse,
neglect, mistreatment or exploitation substantiated against me. As a condition of
submitting my application and in order to verify this affirmation, I hereby
authorize Help At Home, LLC, Tennessee Department of Intellectual and
Developmental Disabilities, and Bureau of TennCare to have full and complete
access to any and all current or prior personnel or investigative records, from
any party, person, business, entity or agency, whether governmental, or
non-governmental, as pertains to any allegations against me of abuse, neglect,
mistreatment or exploitation and to consider this information as may be deemed
appropriate. I further authorize Help At Home, LLC to provide any applicable
information in personnel or investigative records concerning my employment to my
future employers involved in providing DDID services.
IMPORTANT: You must enter your first name and last name to agree to the terms.