Conditions of employment are stated at the end of this form. Please read carefully before you sign this application.Application must be completed in full even if attaching a resume.
Licenses (Include Driver's License)
I, the undersigned hereby authorize and request any present or former employer, school, or other persons having personal knowledge about me, to furnish Camarena Health and their agents with any and all information in their possession regarding me in connection with an application for employment. I am willing to acknowledge a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from any present or former employer who may provide information based upon this authorized request. I understand this authorization is to be part of the written employment application which I sign.
I grant authorization of my own free will, without threats or coercion and understand that in signing this waiver, I have a right to receive a copy of this authorization.
Dates
Please list the names of persons that you have known for at least a year and are not related to you.
I CERTIFY that the information provided in this application is true, correct, and complete. If employed, any misstatement or omission of fact on this application could be considered grounds for dismissal regardless of when and how it is discovered. I understand that acceptance of an offer of employment is not contractual. The application will be given every consideration, but its receipt does not imply that the applicant will be employed. I authorize the investigation of all statements and information contained in this application. I release from liability anyone supplying such information and I also release the employer from all liability that might result from investigation. Camarena Health is an at-will employer.
I acknowledge that I have read and understand the above statement and hereby grant permission to confirm the information supplied on this application by me.
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