Please fill out the the required information outlined in red to proceed to the next section!
Confirmation of Understanding
Select boxes to designate understanding
1. All of the information given by me in this application is correct and complete to the best of my knowledge. I understand and agree that any misrepresentation, falsification or willful omission of facts shall be sufficient cause for refusal of employment or immediate dismissal.
Please Confirm Understanding * 
2. I further understand that employment is contingent upon the successful completion of a physical examination by a physician undertaken solely for the purpose of ascertaining whether I am able to perform the job-related duties of the position for which I am applying. I further understand that employment is contingent upon negative results of a drug screening test and is additionally contingent upon your investigation of my records, references and the OIG Medicare exclusion list. Continued employment is contingent upon successful completion of a probationary period based on my job classification. I understand and agree any misrepresentation, falsification, or willful omission of facts and/or information for these pre-employment tests shall be sufficient cause for refusal of employment or immediate dismissal.
Please Confirm Understanding * 
3. I hereby grant Avon Oaks permission to investigate any information in the application and release all parties (companies, schools or persons named by me in this application) from all liability for any damages for issuing this information. I agree to abide by present and subsequently issued rules of Avon Oaks if employed. Use of this blank does not indicate that there are any positions open and does not obligate Avon Oaks.
Please Confirm Understanding * 
4. I understand that agreement to resolve all disputes or claims related to my employment through Avon Oaks’ Dispute Resolution Procedure (DRP”) is a condition of employment with Avon Oaks. I further understand that if I am hired by Avon Oaks I will be required to sign an agreement whereby I agree to resolve all disputes or claims relating to my employment, including legal claims of unlawful employment, discrimination or wrongful discharge, but excluding claims for workers’ compensation or unemployment compensation benefits, through DRP and further to waive any right to seek resolution of such disputes or claims in any other form.
Please Confirm Understanding * 
5. I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice. I have read, understand, and by my signature consent to these statements.
Please Confirm Understanding * 
Please select this box to act as your Signature * 
Date * 
**This Application for employment will remain on file and active for a limited time, subject to Avon Oaks policies. **