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APPLICANT’S STATEMENT AND AUTHORIZATIONS

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION AND AUTHORIZATIONS.

(Step 1 of 4)

Northwest Mental Health Managment Services, Inc. is an equal opportunity employer and does not discriminate based on race, religion, sex, sexual orientation, age, national origin, ancestry, veteran status or disability.    

 

Interviews are given on a competitive basis, using job-related factors, after a written application has been received and reviewed. Because of the large number of applications received, not everyone who applies for a position will be interviewed.    

 

I certify that I have answered truthfully and have not knowingly withheld any information relative to my application. I understand that any misrepresentation or material omission of this application will result in my being eliminated from further consideration. I further understand that, if accepted for employment, any misrepresentation or material omission which becomes known to Northwest Mental Health Management Services, Inc., will result in immediate termination of employment.    

 

To further my application, I have completed, dated and signed, and attach hereunder by reference, a DISCLOSURE REGARDING CONSUMER REPORT BACKGROUND CHECK, an ACKNOWLEDGEMENT AND AUTHORIZATION FOR BACKGROUND CHECK and PERSONAL DATA sheet to be used by Northwest Mental Health Mangement Services, Inc., including but not limited to a motor vehicle driving record.    

 

I release Northwest Mental Health Management Services, Inc. and all previous employers and supervisors from liability for any damages that may result from furnishing information.  

 

 I understand that, if selected, I will be required to provide proof of my identity, and my legal right to work in the United States prior to actual employment. I also understand that I will be asked to submit to a criminal history review and a pre-employment drug-test. In consideration of my employment, I agree to conform to the instructions, rules, policies and procedures of Northwest Mental Health Management Services, Inc. My employment and compensation can be terminated at any time, with or without cause and with or without notice, at the option of either agency or myself. I understand that no representative or the agency has the authority to enter into any agreement for the employment for any specific period of time, or to make any agreement contrary to the foregoing.

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Headquarters

 1020 Portland Ave. Gladstone, OR 97027 

nwmh@mynwmh.org 
Tel: 503.655.6674 
Fax: 503.655.6737

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