List present employer first.

I certify that the following information contained in this application is true and complete; any falsification, misrepresentation or omission on the application may result in not being hired or being discharged.

I authorize my current and previous employers and educational institutions, any law enforcement or other government agencies, and any references to release any information to Mission Health Services and its subsidiaries that it deems necessary to evaluate my application for employment, unless the release of such information is prohibited by law. I understand that such information will not be disclosed to me, except as required by law. I release Mission Health Services and all other organizations and individuals from liability in connection with the release and use of such information.

I understand that any offer of employment to me is contingent upon this facilities decision within its sole discretion that the results of my criminal background check, drug screen and/or other reference and credential checks are satisfactory.

I understand that the at-will nature of my employment can only be modified through written employment agreement signed by the company president and by me. I understand that no other member of the company’s management staff has the authority to make written or oral promises or guarantees of employment that would alter my at-will employment status.

A photo static copy of this authorization and release may be accepted in lieu of the original.

I agree that as a condition of accepting employment at the facility, I will be subject to the Facility’s policy regarding substance abuse. Specifically, as a condition for consideration of my application for employment, I agree to undergo testing for prohibited drugs and/or alcohol. I further understand and agree as a condition of my employment, I will be required to submit to testing for drugs and/or alcohol under the following circumstances:

I am discovered using, possessing or distributing prohibited drugs or alcohol in violation of the Facility’s Substance Abuse Testing or Drug-Free Workplace Policy;

I appear to be under the influence of drugs or alcohol, appear unable to perform my regular duties in a safe and proficient manner or other circumstances exist which create reasonable suspicion that I may have a substance abuse problem, such as an unexplained change in my temperament, speech, physical or mental condition, energy level, or appearance;

There are recurring or serious problems with my job performance, attendance or behavior where no other verifiable basis for such problem exists;

I am involved in an on-the-job accident that results in injury to me or any other individual which requires medical treatment, or which results in damage to Facility property or the property of another;

I commit an unsafe act that endangers the lives or safety of other employees, residents, patients or other individuals or endangers facility property;

As a requirement for promotion or transfer;

Upon returning from a lay-off or leave of absence exceeding 30 days;

As a condition of participation in the Facility’s Drug & Alcohol Rehabilitation Referral Program.

I understand that the purpose of the drug/alcohol testing is to determine or rule out the presence of prohibited substances in my body for performance and safety reasons. I understand as a condition of employment, if I refuse to comply with the Facility Substance Abuse Policy, I will face disciplinary action, up to and including discharge.

Prohibited drugs are defined to include:
Controlled substances including, but not limited to, amphetamines, barbiturates, benzodiazepines, cannabinoids (marijuana), cocaine, phencyclidine (PCP), opiates, methaqualone;
Prescription drugs which have not been specifically prescribed by a licensed physician, prescribed for the employee, or are not being used for or in the manner prescribed; or
Over-the-counter medications that are not being used for or in the manner recommended.

I understand that should the results of the initial drug/alcohol screening be positive, I may request that confirmatory testing be done by the Facility’s designated laboratory at my expense. If the confirmatory test is negative, the Facility will reimburse me for the cost of the confirmatory test.

I understand that pursuant to Facility policy, the Facility may search my property and me if reasonable suspicion exists to believe that I have violated the Drug-Free Workplace or Substance Abuse Testing Policies. As a condition of employment, I consent to all such searches.

I consent to and authorize the facility and any physician, laboratory, hospital or medical professional retained by the facility to both conduct such testing and to provide the results to the facility. I release the facility, their employees, agents, contractors and successors and assigns from any liability whatsoever arising from the request to undergo drug/alcohol testing, the testing procedures and any decisions made concerning continued employment based upon the results of the tests ducted.

I acknowledge that I have received a copy of the Facility’s Drug-Free Workplace Policy with a schedule of any prohibited drugs. I also acknowledge that I have been informed of the Facility’s drug-free awareness program as required by the Drug-Free Workplace Act of 1988. I have been informed of (1) the dangers of drug abuse in the workplace; (2) the Facility’s policy of maintaining a drug-free workplace; (3) any available drug counseling, rehabilitation and employee assistance programs; and (4) the penalties that may be imposed upon employees for drug abuse violations.

I have also been informed that I must, as a condition of employment, abide by the terms of the Facility’s Drug-Free Workplace Policy, and that I must report any criminal drug statute conviction committed in the workplace to my supervisor within five (5) days of such conviction. I understand and agree that I may be subject to substance abuse testing and searches in accordance with this and other applicable Facility policies. I understand that should I fail to abide by this policy, including but not limited to submitting to a substance abuse test or search, that I may be discharged.

I have read the policy, I understand what is required of me under the policy, and I agree to abide by it.

Review your responses above, then agree to the term below and hit "SUBMIT" to finalize your application.

Thank you for taking the time to complete our online intake form. Please look for a call from Meadow Peak to schedule your interview in the next 3-7 business days, and be prompt to communicate and participate in our hiring process.