APPLICATION FORM WAIVER, NON-COMPETE AGREEMENT, DISCLAIMER, ATTESTATION STATEMENT, AND SIGNATURE
I verify that all the information which I have provided on this application and in any resumes and exhibits are true, correct and complete. I understand that any false, misleading, incomplete or omitted information will result in rejection of my application or dismissal from employment, whenever discovered. If my application is considered for employment, I authorize Tender Nursing Care, Inc., or any independent back grounding service appointed by Tender Nursing Care, Inc. to conduct an investigation of my suitability for employment and to obtain verification of information that I provided on this application, resumes and exhibits. I authorize such information to be used for any decisions related to my hiring and continued employment. Tender Nursing Care, Inc. will conduct a background and reference check on candidates offered positions of employment. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I understand that any offer of employment is conditional upon meeting job requirements, including successful completion of criminal background checks within required by the State of Ohio, meeting personal care standards (if applicable), orientation, and any required testing.
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Tender Nursing Care, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Tender Nursing Care, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
Employment is subject to completion of pre-employment procedures, including but not limited to, verifying employment and personal references, as appropriate criminal background check and driving record, and verification of licensure, certification or registration. In addition, if hired, applicants must complete a Federal I-9 form and provide verifiable documentation of their legal right to reside and work in the United States. I also understand that offer of employment may be contingent upon passing a pre-placement physical exam and health screening and may require a drug testing.
If employed, I will comply with all policies, procedures and work rules. In the event that I am photographed or interviewed during the course of my employment, Tender Nursing Care, Inc. has my permission to use any and all materials gathered.
Tender Nursing Care is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.
In consideration of the orientation and training to be provided by Employer to the Employee, Employee will not, either during employment with Employer or for a period of two years thereafter, directly or indirectly, for himself/herself or any third party, accept employment or engage in any business or activity which is directly or indirectly in competition with Employer. Employee will not solicit any current customer or potential customer of Employer identified during the course of employment with Employer, or otherwise divert or attempt to divert any existing business of Employer. Employee will not, either during employment with Employer or for a period of two years thereafter, either directly or indirectly, for Employee or any third party, solicit, induce, recruit, or cause another person in the employ of Employer to terminate his/her employment for the purpose of joining, associating or becoming employed with any business or activity which is in competition with any products and/or services sold, marketed, or provided by Employer. The geographical area to which this non-competition agreement applies is any area in which Employer currently solicits or conducts business, and/or any area in which Employer plans to solicit or conduct business for a period of two years after Employee leaves employment with Employer. Both parties agree that the time and scope of this Non-Competition agreement are reasonable. If a court finds the time and/or scope of this Non-Competition agreement unreasonable, it should reasonably modify the agreement to protect the Employer to the maximum permitted by law.
I, the undersigned, recognize the rights of Tender Nursing Care, Inc. and agree not to be employed by the client or their representative for a period of two years following termination of my assignment. I further agree not to accept employment from any health care agency that may provide services to a client who received my services through Tender Nursing Care, Inc. for a period of two years following termination of an assignment with Tender Nursing Care, Inc. However, in the event I, a Tender Nursing Care, Inc. associate, am hired by the client or another agency that will be servicing the client I shall pay Tender Nursing Care, Inc. the sum of $2,500.00 as liquidated damages per client as well as any other damages awarded as by the courts. I agree to abide by the terms and conditions outlined in the Associate Handbook as well as Tender Nursing Care policies and procedures.
I have reviewed and attest that I have not been convicted or plead guilty to any of the disqualifying offenses listed below from the Ohio Administrative Code 5123:2-1-05. 1 (J) (1) through (J)(4):
(J) No person may be placed in a direct services position if the person has been convicted of or plead guilty to any of the following:
1. A violation of the following sections of the Revised Code:
2903.01 Aggravated murder
2903.03 Voluntary manslaughter
2903.04 Involuntary manslaughter
2903.11 Felonious assault
2903.12 Aggravated assault
2903.16 Failing to provide for a functionally impaired person
2903.21 Aggravated menacing
2903.34 Patient abuse and neglect
2905.05 Criminal child enticement
2907.03 Sexual battery
2907.04 Unlawful sexual conduct with a minor, formerly corruption of a minor
2907.05 Gross sexual imposition
2907.06 Sexual imposition
2907.09 Public indecency
2907.21 Compelling prostitution
2907.22 Promoting prostitution
2907.31 Disseminating matter harmful to juveniles,
2907.32 Pandering obscenity
2907.321 Pandering obscenity involving a minor
2907.322 Pandering sexually oriented matter involving a minor
2907.323 Illegal use of minor in nudity-oriented material or performance
2911.01 Aggravated robbery
2911.11 Aggravated burglary
2919.12 Unlawful abortion
2919.22 Endangering children
2919.24 Contributing to unruliness or delinquency of child
2919.25 Domestic violence
2923.12 Carrying concealed weapon
2923.13 Having weapons while under disability
2923.161 Improperly discharging a firearm at or into a habitation or school
2925.02 Corrupting another with drugs
2925.03 Trafficking in drugs
2925.04 Illegal manufacture of drugs or cultivation of marihuana
2925.05 Funding of drug or marihuana trafficking
2925.06 Illegal administration or distribution of anabolic steroids
3716.11 Placing harmful objects in food or confection
2905.04 Child stealing) as it existed prior to July 1, 1996,
2919.23 Interference with custody that would have been a violation of
2905.04 of the ORC as it existed prior to July 1, 1996, had the violation occurred prior to that date
2925.11 Possession of drugs that is not a minor drug possession offense as defined in this rule
Felonious sexual penetration in violation of former section 2907.12 of the Revised Code
2. A felony contained in the Revised that is not listed in paragraph (J)(1) of this rule, if the felony bears a direct and substantial relationship to the duties and responsibilities of the position being filed;
3. Any offense contained in the Revised Code constituting a misdemeanor of the first degree and a felony on a subsequent offense, if the offense bears a direct and substantial relationship to the position being filed and the nature of the services being provided;
4. A violation of an existing or former municipal ordinance or state law of this state, any other state, or the United States, if the offense is substantially equivalent to any of the offenses listed or described in paragraph (J)(1), (J)(2), or (J)(3) of this rule.
I also agree that I will notify my employer within 14 calendar days if, while employed with this agency, I am ever formally charged with, convicted of, or plead to any of the offenses listed or described in paragraph (J)(1), (J)(2), or (J)(3) of Ohio Administrative Code 5123:2-1-05. 1 as noted above. Failure to report formal charges, a conviction or guilty plea may result in being dismissed from employment.
By my signature below, I certify that I have read, understand, have been truthful, and agree to the terms of this Application, Waiver, Non-Compete Agreement, Disclaimer, and Attestation Statement.