I hereby affirm that the information provided on GMCF Personal Information Data Form (GMCF Form 8-8) is true and complete to the best of my knowledge. I also agree that any false information, representations or omissions may disqualify me from further considerations for training and may result in dismissal from the Nurse Aide Training Program if discovered at a later date.
Before I can begin Nurse Aide Training, I understand I must be able to verify, as required by federal law, that I am authorized to work in the United States. I understand that all applicants offered a position at GMCF must document their authorization to work before the hiring process will be complete. If selected for hire, I understand it will be my responsibility to provide GMCF with documentation establishing my right to work. I understand these documents will be reviewed at the time a conditional offer of employment is made.
I authorize a thorough investigation of my past employment and education, including discipline records, and agree to cooperate in such investigation. I release from all liability and responsibility all persons, corporations and/or educational institutions requesting or supplying such information and waive any right to notice of such disclosure.
I understand that part of GMCF's screening process may include a search of criminal conviction history records to verify information provided by me during the application process. As a part of this investigation, I may be required to provide my date of birth, sex, driver's Jicense and state of issue. I understand that this information may be required at a later time to facilitate this investigation. My signature below signifies that I understand and agree to authorize GMCF to secure criminal conviction history from the appropriate law enforcement agency, should GMCF determine it necessary to do so.
I agree to submit to any physical testing and a urine drug screen, which may be necessary to determine my ability to participate in the training for which I am being considered. I further authorize any physician or entity conducting such medical examination to release the results of such examination to GMCF.
I understand that if I am granted an interview, I will be asked at that time if I can perform the essential function of the training for which I am applying, with or without reasonable accommodation. I also understand that if I have protected disability that affects my ability to do the training I seek, I may ask GMCF to attempt to make a reasonable accommodation for it. Under federal law, it is my responsibility to inform GMCF that accommodation is needed. I understand I must make my request for accommodation in writing to the Personnel Supervisor as soon as possible. Under state law, such request must be made no later that 182 days after the date I know or reasonably should know that accommodation is needed.
If accepted into the Nurse Aide Training Program, I agree to abide by the rules and policies of GMCF. I understand that my training with GMCF is for 3-week term, and I am subject to dismissal at any time if these policies and procedures are not followed.
