Job 1

Reference 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 or termination of my employment.

I understand that Blair Senior Services, Inc. will make a thorough investigation of my entire employment experiences, education and all other aspects of my background relevant to my proposed employment and may verify all data in this application, related papers or oral interviews. I authorize such investigation and the giving and receiving of any information requested by Blair Senior Services, Inc. I release Blair Senior Services, Inc., it's employees and any person involved in the sharing of such information from liability arising from such investigation. I understand that the falsification of data so given or other derogatory information discovered as a result of this investigation may prevent my being hired or if hired, may subject me to immediate dismissal.

I understand that when Blair Senior Services, Inc. is in receipt of information which is part of an applicant's criminal history record, Blair Senior Services, Inc. may use that information for the purpose of deciding whether or not to hire the applicant. Felony and misdemeanor convictions shall be considered by Blair Senior Services, Inc. only to the extent to which they relate to the applicant's suitability for employment in the position for which he or she has applied. I understand that Blair Senior Services, Inc. will notify applicants in writing if the decision not to hire the applicant was based in whole or in part on criminal history record information.

Subsequent to an offer of employment, I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of the job position. I understand that the offer of employment may be conditioned upon my ability to perform the essential functions of the job with or without reasonable accommodation from Blair Senior Services, Inc.

Although the Agency makes every effort to accommodate individual preferences, at times Agency needs may make the following conditions mandatory: overtime, shift work, a rotating work schedule or a wore schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

I understand that this is an application for employment and that no employment contract is being offered. I understand that if I accept employment with Blair Senior Services, Inc. it will be on an at-will basis. This means that either Blair Senior Services, Inc. or I have the right to terminate the employment relationship at any time without liability for wages or salary except such as may have been earned at the date of such termination. I also understand that Blair Senior Services, Inc. may change wages, salaries and/or benefits at any time.

The following positions require heavy lifting:

All Food Service positions (Including Meal Delivery Drivers)
All Home Delivered Meals positions
IT Systems Administrator
Maintenance
Mechanic
Senior Center Coordinator
Vehicle Operator

I understand that heavy lifting is an essential function of the position for which I am applying.

I have read and understand the Agreement terms.