I certify that all statements made in this application (and accompanying resume, if applicable) are true
and accurate to the best of my knowledge and that I have not knowingly omitted any relevant material. I
understand that any material omission or misrepresentation will result in my disqualification from
consideration for employment or, if discovered after I begin employment with Eastern Star Masonic Home
may result in my termination.
I hereby authorize release of information for purposes of this application. I hereby authorize Eastern Star
Masonic Home to contact the references listed as well as the current/former employers listed and discuss
my professional and/or work-related qualifications, my character and fitness for the position for which I
am applying. I hereby authorize persons, schools, my current employer (if applicable) and previous
employers or other organizations to provide this facility and its affiliates with any requested information
regarding my application or suitability for employment. I completely release all such persons or entities
from any and all liability related to the providing or use of such information.
I understand that a comprehensive background check will be conducted to determine my eligibility for
hire. This may include, but is not limited to, criminal records check, child abuse/dependent abuse registry
check, and sex offender registry. I also understand that a physical examination may be required for
certain positions. I consent to take the physical examination, and such future physical examinations as
may be required by this institution at such times and places as the institution shall designate. I understand
that an offer of employment may be contingent on passing the physical examination which relates to the
essential duties I would be required to perform.
I hereby release Eastern Star Masonic Home and other persons or entities from any claims or liability that
may arises or based on the decision to conduct a reference and/or background check.
I understand that, if hired, my employment is considered to be at will and can be terminated by either
party at any time with or without cause. Eastern Star Masonic Home reserves the right to terminate
without any notice. I understand that this application and any other handbook or documents which I may
receive does not constitute a contract of employment with Eastern Star Masonic Home. I acknowledge
that any offer of employment is conditional and may be withdrawn at any time.
If employed, I will be required to complete an Employment Verification Form (I-9), and within three days
show satisfactory evidence of identity and eligibility for employment.