Employment Form

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

Personal Information

Educational History

Employment Record

Please include all employment for the last five years

References

Please do no include relatives or former employers.

Work Availablity

• If your application receives favorable consideration, when will you be available to being work?
• Do you have any objection to working overtime?
  No Yes
• Can you work overtime without prior notice?
  No Yes
• Can you work on Saturday?
  No Yes
• Can you work on Sunday?
  No Yes
• Can you travel if required by this position?
  No Yes

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

• 1. I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire and termination of my employment.
• 2. I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with Clarity Way creates an actual or implied contract of employment. I understand that if I accept employment with Clarity Way, it will be on at-will basis. This means that either Clarity Way or I have the right to terminate the employment relationship at any time, for any reason, with or without cause. If my employment is terminated, Clarity Way is liable only for wages or salary earned as of the date of termination.
• 3. I agree to submit to drug and alcohol testing if requested by Clarity Way. I release Clarity Way, its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing.
• 4. I authorize Clarity Way to investigate information concerning my education, employment experiences and all other aspects of my background relevant to my proposed employment. I release Clarity Way and its employees from all liability arising from such investigation.
• 5. Any doctor, hospital or testing laboratory has my consent to conduct medical or drug testing on me and I hereby give my consent to having all information released for Clarity Way to determine my abilities to perform job duties now or in the future.
• 6. I understand that Clarity Way requires all staff to report sanction, convictions, suspensions, censures or revocation action taken against them by federal, state, local, or other professional entities. These sanctions may include but are not limited to infractions against professional licensure, criminal history convictions, fraud convictions, history of child abuse, managed care organization infractions, etc.
• 7. This application is current and active for only six months. At the conclusion of this time, if I have not had any contact from Clarity Way and still wish to be considered for employment, it will be necessary for me to complete a new employment application.
• 8. If employed I understand that I must abide by Clarity Way policies and procedures and all PA Department of Health Staffing Regulations pertaining to Drug and Alcohol Treatment Facilities.

I have read and agree to the above and hereby attest that the information provided in this application is true and complete to the best of my knowledge.