APPLICANT CERTIFICATION & AGREEMENT: (Read carefully before signing)
By electronically signing, I grant permission to Cardinal Ritter Senior Services to investigate thoroughly my complete personal, educational and work histories, and to verify all information that may be given in connection with my seeking of employment with them. I also grant permission to Cardinal Ritter Senior Services to contact, in connection with my application and periodically thereafter if I am employed, the Missouri Division of Family Services and any other agencies, organizations, corporations, entities, or individuals that Cardinal Ritter Senior Services deems necessary in order to verify the continued accuracy of any information given in connection with this application. I agree to complete, in connection with my application and periodically thereafter if I am employed, any and all forms required by Cardinal Ritter Senior Services (including, but not limited to, an application for child screening form to be submitted to the Missouri Department of Social Services). In addition, I release Cardinal Ritter Senior Services and all of its agents, as well as any individual or organization and all of their agents who supply or information regarding myself to Cardinal Ritter Senior Services, from any and all liabilities resulting from such investigation or verification. I understand and agree that I may be denied employment or, if I am already employed, that my employment may be terminated based on information obtained during that investigation or verification. Upon termination of my employment with Cardinal Ritter Senior Services, regardless of when, how or why my employment is terminated, and whether such termination is affected by me or by Cardinal Ritter Senior Services, I authorize the release of information on all aspects of my employment history with Cardinal Ritter Senior Services and release the Cardinal Ritter Senior Services and all its agents from any and all liability resulting from disclosure of information on my employment history. In addition, I understand and agree that this application will be considered valid for a period of ninety (90) days. I recognize that if I wish to be considered after ninety (90) days, I must complete a new application for employment. I understand and agree that if am offered employment by Cardinal Ritter Senior Services, my employment will be based upon mutual agreement and that either I or Cardinal Ritter Senior Services may terminate the employment relationship at any time and for any reason. I further understand that no supervisor, agent or representative of Cardinal Ritter Senior Services has any authority to enter into any oral employment agreement with me for any period of time or to make any oral agreement contrary to the foregoing. Finally, I certify that I have given true and accurate information and that I have read and agreed to the conditions of employment stated in this application and authorize the release as set forth above. If any information contained in this application is found, in opinion of Cardinal Ritter Senior Services, to be false in any respect, my application for employment may be rejected. Similarly, if I am already employed, I will be subject to discharge without notice at any time.
Enter your name in the text box below to sign your application and agree to these terms.
Equal Employment Opportunity
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.
The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.
Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender
Male
Female
I choose not to disclose this information
Ethnicity
Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)
Not Hispanic or Latino (if not Hispanic or Latino, please address race below)
I choose not to disclose this information
Race (do not respond if you selected "Hispanic or Latino" above)
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
A all persons who identify with more than one of the above five races
I choose not to disclose this information
Protected Veterans
The definitions of protected veterans are listed below. Use the boxes following the definitions to indicate whether you are a protected veteran
Disabled Veteran
A "disabled veteran" is one of the following:
Recently Separated Veteran
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
Active Duty Wartime or Campaign Badge Veteran
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Service Medal Veteran
An "armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
I am not a Protected Veteran
I choose not to disclose this information
Disability Status
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Yes I have a disability (or previously had one)
No I don't have a disability
