Certification and Authorization – Please read thoughtfully
I certify that all facts contained in the application are true and complete and acknowledge that GWF is relying on the accuracy of the information provided. I authorize GWF to verify the accuracy of the information provided herein, and I authorize former employers and educational institutions to release information concerning me to GWF. I also authorize GWF to contact at least three references herein provided by me.
I further understand and agree that GWF shall document, pursuant to 5126.281 of the Revised Code and rules 5123:2-1-05 and 5123:2-1-05.1 of the Administrative Code , that any person hired as administrator, direct care staff, caseworker, or in any other position responsible for the care of an individual with disabilities shall not have been convicted of or pleaded guilty to any of the offenses listed.. This documentation may include fingerprinting and/or FBI background checks.
This will include background checks as defined in division (G) of section 5123.50 of the Revised Code are listed on the abuser registry established pursuant to sections 5123.50 to 5123.54 of the Revised Code.
Additionally, checks will be made to determine if any applicants who are listed on the nurse aide registry, established under section 3721.32 of the Revised Code, indicating that the director of the Ohio department of health has made a determination of abuse, neglect, or misappropriation of property of a resident of a long-term care facility or residential care facility by the person.
I understand that falsification, misrepresentation or omission of requested facts may result in denial of employment or, if employed, may result in immediate dismissal.
I understand and agree that, if hired, my employment will be for no definite period and may, regardless of the date of payment of wages, be terminated at any time without previous notice and with or without reason, at the will of either myself or GWF.