25000 Country Club Blvd. Suite 255, North Olmsted, OH 44070
440.793.0200
1 2 3 4 5 6 7 8

APPLICATION FOR EMPLOYMENT

Highbanks Care Center


Applicant Notice: You are applying for employment with the above listed Facility. To be eligible for employment, you must read and agree to the following ‘conditions of employment;’ then sign below.

THIS IS A DRUG-FREE WORKPLACE

ANY PERSON EMPLOYED BY THIS FACILITY SHALL BE SUBJECT TO RANDOM DRUG OR ALCOHOL TESTING AT ANY TIME AND AT THE FACILITY’S DISCRETION.
********************

POST- EMPLOYMENT PHYSICAL

THIS FACILITY REQUIRES ALL EMPLOYEES TO HAVE A MEDICAL EXAMINATION. AFTER AN EMPLOYMENT OFFER HAS BEEN MADE TO A JOB APPLICANT AND BEFORE THE APPLICANT BEGINS THEIR EMPLOYMENT DUTIES, THEY MUST HAVE A MEDICAL EXAMINATION.

ALL OFFERS OF EMPLOYMENT ARE MADE CONTINGENT ON THE MEDICAL EXAMINATION RESULTS. THE SUCCESSFUL APPLICANT MUST BE QUALIFIED AND MUST BE ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THE POSITION THEY HAVE APPLIED FOR, WITH OR WITHOUT REASONABLE ACCOMMODATIONS.
********************

CRIMINAL RECORD’S CHECK

TO BE ELIGIBLE FOR EMPLOYMENT WITH THIS FACILITY, EVERY EMPLOYEE WILL BE CHECKED AGAINST THE OIG EXCLUSION CHECKLIST (PRE-EMPLOYMENT and PERIODICALLY POST-EMPLOYMENT). EVERY EMPLOYEE MUST SUBMIT TO A CRIMINAL RECORDS CHECK WITHIN 5 DAYS OF EMPLOYMENT.

WHEN EMPLOYED, THE APPLICANT WILL BE CHARGED $22.00 FOR THE COST OF THE BCI&I (Ohio Bureau of Criminal Identification and Investigation) CRIMINAL RECORDS’ CHECK. IF THE EMPLOYEE-APPLICANT HAS NOT BEEN A RESIDENT OF OHIO FOR MORE THAN 5 YEARS, THEY WILL ALSO BE CHARGED $29.00 FOR THE COST OF THE FBI (Federal Bureau of Investigation) CRIMINAL RECORDS CHECK.

THE COST OF THE RECORDS CHECK SHALL BE DEDUCTED FROM THE EMPLOYEE’S FIRST PAYCHECK, THROUGH A PAYROLL DEDUCTION. BECAUSE THIS IS A ‘CONDITION OF EMPLOYMENT,’ AN APPLICANT WILL NOT BE CONSIDERED FOR EMPLOYMENT WITHOUT THEIR AGREEMENT TO PAY FOR THE REQUIRED CRIMINAL RECORDS’ CHECK. (Your signature is required below.)
********************
I have read and understand the above listed requirements. I understand my employment with the Facility is “at will” and is contingent upon the successful passage of my criminal background check, past employment references and my post-employment medical examination.

With my signature, I certify that I currently not under investigation for or been convicted of a crime that may exclude me from employment in a nursing facility. I also understand that a criminal records check is a condition of employment and that I will be responsible for the cost of said records’ check. I HEREBY APPROVE the deduction of the associated cost of said records check(s) from my paycheck.
Print Applicant’s Name
Date
xv
Next Page