Employee Handbook Acknowledgement Form

I understand that in processing my application with Agency an investigation may be made in which information is obtained through personal interviews, and a review of information held by law enforcement or other government agencies. I authorize you to verify my past employment and education, criminal records, motor vehicle records, personal references, and other job related data provided on this application, or via the interview process. I authorize appropriate individuals, companies, institutions or agencies to release information, and I release them from any liability as a result of such inquires or disclosures. A consumer report may be generated summarizing this information. I further understand and waive my right of privacy in this investigation and release and hold harmless Agency from any liability. I agree that any decision to hire me is contingent upon the results of my report and certify that all statements and answers on my application, resume, or Interview are true and complete to the best of my knowledge. I understand that if any statements are false or that if information has been omitted, this will be cause for disqualification and immediate termination of my employment if employed. I further authorize Agency to check my credit and conviction records, as needed, on a continuous basis as it relates to my employment. I am granting Agency authorization to release confidential medical Information upon the request from Agency clients while I am actively working at the client’s facility and /or during the profiling and placement processes.

I understand that Agency's goal is to always provide me with a consistent level of service. If for any reason I am dissatisfied with Agency' service or the service provided by one of Agency Clients, I am encouraged to contact the local manager to discuss the issue. Agency has processes in place to resolve customer complaints in an effective and efficient manner. If the resolution does not meet my expectation, I am encouraged to call the Agency corporate office. A corporate representative will work with me to resolve my concern. I understand that any individual or organization that has a concerns about the quality and safety of patient care delivered by Agency healthcare professionals, which has not been addressed by Agency management, is encouraged to contact the State Regulatory. Agency demonstrates this commitment by taking no retaliatory or disciplinary action against employees when they do report safety or quality of care.

I have read and understand the entire Agency policies and my requirements. I understand that if I have any questions and/or need clarification for items addressed in the handbook, it is my responsibility to contact the Agency office to discuss.