AFFIDAVIT
I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind whatsoever. I agree that my employer shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers or omissions made by me in this questionnaire. I authorize employers, companies, schools or persons named above to give any information regarding my employment, together with any information they may have regarding me, whether or not it is in their records. I hereby release said employers, companies, schools or persons from all liabilities for any damage, both legal and otherwise, for issuing this information. If accepted for employment, I hereby agree to abide by the rules and policies of my employer.
I realize that TCMH operates 24 hours a day, 7 days a week, and that although an initial schedule has been explained to me, I realize I may be required to work differing schedules with changes in the days of the week I work, differing shifts, and greater or fewer days in a pay period depending on the census of patients.I understand that in order for the hospital to maintain its standards of care and orderly operation, I may be required to sometimes work overtime.
I authorize any reference source to provide TCMH with any and all information concerning my previous work and/or school records and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.I further agree that TCMH may furnish like information to those with whom I may hereafter seek employment and hereby agree to save TCMH free and harmless from all any and all liability therefore.
I am aware that a criminal background check will be done as required by Missouri Law.I understand TCMH will follow Missouri House Bill 1362 regarding eligibility for employment if I have been convicted of Class A or B felony.
Further, I understand that any employment is not for a stated period of time and may be terminated, with or without cause, at anytime, at the option of either myself or my employer.In addition, TCMH is a Drug Free Work Place and under the Drug Free Work Place Act of 1988, I agree to abide by such established policies as relates thereto.I also understand that ALL JOB OFFERS ARE CONDITIONAL ON PASSING A REQUIRED DRUG SCREENING WITHIN 24 HOURS OF AN OFFER.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
A COPY OF THIS COMPLETED APPLICATION IS AVAILABLE TO YOU ON REQUEST.
