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General Information
Employment Agency
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Employment History
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Personal References
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Employee Application Work History

Work References

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Full Time Part Time Voluntary
I certify that the information in this application is accurate, current and complete. I understand that misstatements or omissions may result in disqualification from further consideration or termi nation of employment. I authorize Solid Sourc e Healt hcare Re sources to investigate my employment history, credentials and to obtain any relevant information (including a criminal background check) needed to make an emplo yment decision. I authorize SSHCR to disclose th is application along with any information about me obtained through reference checks or during the course of the interview process for state, federal, contractual or accreditation audit purposes. I also authorize SSHCR to disclose any of my performance appr aisals, disciplinary records or skill tests for the same p urposes as above. I release SSHCR and any individual or enti ty providing information to SSHCR from all liability for any damages from the disclosure of this information. I also understand and agree that: Passing a medical examination and/or participating in a post - conditional offer medical screening may be required. If medical restrictions cannot be reasonably accommodated, I may not be hired, or if hired, employment may be terminated. I may be subje ct to pre - employment drug testing, or a drug test where a reasonable suspicion exists, or where warranted by circumstances, workplace conditio ns or contractual requirements. I understand and agree that nothing contained in this employment application or in granting of an interview creates an employment contract between SSHCR and myself for either employment or for the providing of any benefit. No promises regarding employment h ave been made to me. If an employment relationship is established, I understand that my employment will be terminable “at will,” that I will have the right to terminate my employment at any time, and that SSHCR will retain a similar right to terminate my em ployment at any time. I understand that should I become employed by SSHCR , my work assignments, schedules and/or work locations are subject to change according to the needs of the business and the clients of Solid Source Healthcare resources LLC

Pursuant to Title VII of the Civil Rights Act of 1964 (42 U.S.C. C2000d et seq.) and 45 C.F.R. part 80, section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. d794) and 45 C.F.R. part 84, and the Age Discrimination Act of 1975 (42U.S.C. d6101 et seq.) and 45C.F.R. part 91, the company adheres to an equal opportunity policy for all persons seeking admission as clients or seeking employment or for all person employed by the company. The company does not discriminate becaus e of age, race, color, religion, military status, marital status, gender preference, sex, national origin or disability.

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