Certified Occupational Therapy Assistant

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I hear-by certify that the information contained in this application form is true and correct. I authorize Bawitdaba LLC dba Geenhaven Healthcare Center to contact any of my schools, former employers or other references for the purpose of collecting information. I agree to hold any or all of them blameless and free of any liability for releasing any such information. I agree to hold any or all of them blameless and free of any liability for releasing any such information. I understand that if I am employed, any deletion, misrepresentation or misstatement of the facts as stated or implied is sufficient cause for dismissal. I understand that this application does not bind the employer or me for any specific period regarding employment. I understand that I will be required as a condition of employment, to successfully complete a physical examination before employment. I understand all offers of employment are conditional on the provision of satisfactory proof-of any applicant's identity and legal authority to work in the United States. I agree to observe all rules regulations and policies of Bawitdaba LLC dba Greenhaven Healthcare Center

I (state your name below) understand that in conjunction with my application for employment, work to be performed under contract, promotion, volunteer position, reassignment, and/or retention ("Work"), Bawitdaba LLC dba Greenhaven Healthcare Center use the services of an outside agency to research and verify the information I have provided on my application for employment, including my personal background, character, professional work history and qualifications, This agency will provide a written report of its findings to Bawitdaba LLC dba Greenhaven Healthcare Center uses ENZIP, a consumer-reporting agency, as an agent to perform its Employment related background investigations. ENZIO will various sources of information, It deems appropriate including but not limited to: criminal conviction records, current and former employers, department of motor vehicle records, military records, credit reporting agencies, education records, professional and personal references and compensation records including any and all injuries in compliance with the Americans with Disabilities Act. agree, authorize and consent to the release and disclosure of any and all information including but not limited to the above to Bawitdaba LLC dba Greenhaven Healthcare Center, and ENZIO. I agree, authorize and consent to the procurement of a Consumer Report and /or an Investigative Consumer Report and understand that it may contain information about my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, this authorization in original or copy form shall be valid for my term of Work from the date indicated next to my signature. According to the Fair Credit Reporting Act, I be notified Bawitdaba LLC dba Greenhaven Healthcare Center if Work is denied because of information obtained from a Consumer Reporting Agency, additionally, I understand that if requested within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information provided to Bawitdaba LLC dba Greenhaven Healthcare Center I further understand that I may request a copy of the report, and that when doing so, proper identification will be required, and I should direct my request to: ENZIO. I understand that residents all states will automatically receive a copy of the report if an adverse action is taken regarding the employment application, or upon request as outlined herein.