I sanction the release to Rocky Mountain Assisted Living (and/or any of its authorized agents) any information held by any parties regarding my prior employment, criminal history record and/or record of convictions in state and local files for violations of any federal, state/regional local statutes or ordinances, any violations of state or federal regulation defending older adults or individuals with disabilities military records, credit history, driving records and educational records and hereby release said persons, schools, companies, government agencies, court and law enforcement authorities from any damage whatsoever for releasing this information. I further authorize Rocky Mountain Assisted Living to use any of the information I have listed above, including my name, address, social security number and driver’s license number to obtain any information referring to the following paragraph.
Rocky Mountain Assisted Living will not intentionally employ or retain employment with any individual who has been unlawfully convicted of one or more of the following, but not limited to: manslaughter, murder, homicide, concealment of a homicidal death, kidnapping, child abduction, criminal child enticement, or contributing to the delinquency of a minor; unlawful restraint or forcible detention, felonious or aggravated assault, menacing, battery, infliction of great bodily harm, sexual assault/battery or sexual abuse, unlawful sexual behavior; abuse or criminal neglect of an elderly or disabled person; theft, financial exploitation, robbery, or burglary of an elderly or disabled person, criminal trespass, arson, illegal control or use of weapons or aggravated discharge of a firearm, manufacturing delivery, or trafficking of controlled substances, felony conviction of possession of controlled substance(s). Continued employment by Rocky Mountain Assisted Living is conditioned upon finding of no criminal convictions of these offenses unless mitigating circumstances (if any) should be taken into consideration.
Rocky Mountain Assisted Living will also not knowingly employ or retain any person who is listed on the HHS-OIG Cumulative Sanctions Report or the General Services Administration’s exclusion list. Continued employment by Rocky Mountain Assisted Living is conditioned upon a finding that said person is not listed on either of the aforementioned lists.
I certify the information I have provided on this authorization is accurate and true. I understand that misstatements, omissions or false or deceptive statements which I have provided on any application, authorization, on my resume` and/or in interviews shall comprise justification for refusal to hire or immediate release from employment.
In deliberation of employment with Rocky Mountain Assisted Living, I agree to comply with the Code of Conduct, policies, and procedures and requirements of Rocky Mountain Assisted Living. I understand and comprehend this application and/or any Rocky Mountain Assisted Living, policy, manual, handbook or other written document describing such items do not constitute a written contract at this time or in the future. I understand my employment would be at will and that my employment could be terminated at any time by either party, with or without cause and with or without notice. Any modification of the at-will employment relationship can only be accomplished by a written document signed by Rocky Mountain Assisted Living’s Manager or Owner.
I have read and understand the above.
