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Start with present or most recent employer. Include contractual and consulting arrangements as well as volunteer work.



If 'Yes', please explain giving date, charge, disposition, and any other details you feel appropriate. NOTE: A conviction does not constitute an automatic bar to employment. Factors such as seriousness of the infraction, date of conviction and how the conviction relates to fitness to perform the job in question will be considered.


I attest that I have never been disciplined or released from employment or contractual/consulting arrangement or had law enforcement investigation or court proceedings due to abuse or neglect of persons supported (clients or residents) or other disciplinary procedures except as noted below. Write "N/A" if not applicable.

I further attest that I have never been sanctioned or disciplined by any employer, contractor, consulting or affiliation source, staffing agency or professional organization to which I currently or previously was affiliated with except as noted below:

I affirm that the information provided on this application (and any accompanying resume or application materials) is true and complete to the best of my knowledge. I agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I understand and accept that employment with BARC Developmental Services is an at-will relationship, and that it may be terminated by BARC Developmental Services or by me at any time and for any reason, without cause or notice.

I understand that there is no guarantee of continued employment with BARC Developmental Services. I understand that any offer of employment is conditional upon my successful completion of a physical examination. I understand that there is no promise of any kind by BARC Developmental Services contained in any written or oral statements made by anyone interviewing me for this position.

I hereby give BARC Developmental Services the right to conduct a background investigation of myself as a condition of employment, which may include, but is not limited to, reference checks, criminal history and FBI clearances, child abuse history clearance, and motor vehicle record. I authorize persons, schools, current and previous employers and organizations name in this application (and any accompanying resume or application materials) to provide BARC Developmental Services any relevant information that may be required to arrive at an employment decision. I understand that BARC Developmental Services will consider such information personal and confidential. I release BARC Developmental Services, its officers, agents and associates, and all previous employers from any and all liability resulting from such verification and investigation.

I have read and understand the above content and providing my name in this box acts as my electronic signature.