Board of Directors
May 27, 2022
A Place of Hope,
A Mission of Caring
Board of Directors
Notice to Applicants
The Center is an equal opportunity employer and does not discriminate on the basis of an applicant’s or employee’s race, color, religion, sex, national origin, citizenship, age, physical or mental disability, or any characteristics.
Prospective employees are subject to, and must pass, background checks including child and adult maltreatment, state criminal, and/or FBI.
Employees must pass a drug test upon hire and are subject to random and reasonable cause drug tests.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility document upon hire.
No action can be taken on this application until all questions have been answered.
Questions with an asterisk* are required.
District of Columbia
Last 4 Digits of Social Security Number:*
(List from present to past)
School/Institution, Major/Area of Study, Degree or Number of Years Studied *
(List current first)
The employers listed above may be contracted unless you indicate the reason why they should not be contacted.
Additional References - WORK RELATED
- Supervisors, etc.
Have you been an Arkansas resident for the past six years?*
Are you prevented from lawfully becoming employed in this country because of VISA or immigrant status? (Proof of citizenship or immigrant status will be required upon hire)*
Have you ever been convicted of a felony?*
If convicted, please explain:
Have you ever been convicted of a Misdemeanor*
If convicted of a misdemeanor, please explain
Conviction may disqualify an applicant from employment
- Read Carefully
I hereby authorize The Gregory Kistler Treatment Center, Inc. to conduct a personal investigation as to my qualifications, experience, background, driving record, etc., and in so doing to contact any person, law enforcement agency or firm it desires. I understand that an investigative consumer report may be made whereby information is obtained through a credit report and personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I authorize my former employers, references, and all other persons named herein who might have information concerning me to give any information regarding my former employment or any other information they may have regarding me whether or not the same is a matter of record, and hereby release them and each of them from any liability for any damage whatsoever which I could or might claim because of such disclosure.
In making this application for employment, it is understood and accepted that as part of the application and employment process, and/or during employment with The Gregory Kistler Treatment Center, Inc., I may be asked to submit to physical examinations which may include testing for alcohol and drugs, and/or be fingerprinted, all in accordance with law. By signing this application, I hereby agree to submit to such examinations, tests, and fingerprinting and release all persons and companies from any liability arising out of such examinations, tests, and fingerprinting. I further understand that I may be subject to random and reasonable cause drug tests if hired.
I understand the use of this form does not indicate there are positions open and does not in any way obligate The Gregory Kistler Treatment Center, Inc. If employed, I agree to abide by and observe all Company rules and regulations. I consent and agree the Company shall have the right to search my personal property located on Company property, along with Company desks, lockers, etc., for the purpose of investigating possible violations of Company rules. I further understand any such future employment is terminable by either party at-will with or without notice or cause. I understand that nothing contained in my employment application, or in granting of an interview, is intended to create an employment contract between The Gregory Kistler Treatment Center, Inc. and myself for either employment or for providing of any benefit. I understand none of the benefits or policies in any handbook issued to me or any rules posted by The Gregory Kistler Treatment Center, Inc. constitute a contract of employment, and are not intended by reason of their publication to confer any right or privileges to said benefits or policies, or to entitle me to be or remain employed by The Gregory Kistler Treatment Center, Inc. or to change my status as an “at-will” employee. I understand that all statements or provisions in any handbook are procedural or are a guideline and The Gregory Kistler Treatment Center, Inc. has the right to change any policy, benefit, or procedure at any time without notice.
My signature below certifies that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that any false or misleading information or omission on the application is cause for rejection or immediate dismissal.
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Direct Care - Waiver