I certify that the answers I have made to all of the questions in this application are true and complete to the best of my knowledge. I understand that if this application is not completed in its entirety, it will not be processed and I will be automatically disqualified. I understand that I am responsible for the correctness of this application. I also understand that the making of false statements will be grounds for rejecting the application outright. If the false statement is not discovered until after I am employed, it will be grounds for removal. Pursuant to Ohio Administrative Code Section 5123: 2-2-2, the Clearwater Council of Governments is required to conduct background investigations for purposes of employment. Please note per 5123: 2-2-02, there are five tiers of disqualifying offenses with corresponding time periods that preclude an applicant from being employed with this agency. Therefore, all applicants under final consideration for employment will be required to submit to a background check through the Bureau of Criminal Identification and Investigation. Your signature below verifies only that you understand our requirement to conduct background checks following job offers. I waive all provisions of law forbidding colleges or university which I attended, or past employers, from disclosing any information which they acquired relevant to my employment. I consent that they may disclose such information to the Human Resources department of the Clearwater Council of Governments. I understand that any offer of employment is conditional upon proof of legal authorization to work in the United States as required by the Immigration Reform and Control Act. Services for Aging, Inc is an equal opportunity employer. Services for Aging, Inc does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Services for Aging, Inc to hire me. If I am hired, I understand that either Services for Aging, Inc or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Services for Aging, Inc has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Services for Aging, Inc true and complete information on this application. No requested information has been concealed. I authorize Services for Aging, Inc to contact the references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.