Drug & Criminal Consent

I have read and understand Unlimited Care, Inc.’s Drug Screen Policy. I agree to abide by the policy and submit to drug screening as stated therein, including any modifications, addition, or deletions that may be established by Unlimited Care ongoing. I also agree to hold harmless Unlimited Care, Inc. from any liability incurred during as a result of drug screening.

I understand that any initial offer of employment or continuing employment is contingent upon results, which establish that I am drug free.

I further understand the meaning of this consent form and have had opportunities to raise questions; and I witness that my signature is voluntary and without coercion or duress.

HAVE YOU EVER BEEN CONVICTED OF, OR ARE PRESENTLY BEING CHARGED WITH OR UNDER INDICTMENT FOR A CRIME?

I have read and understand Unlimited Care, Inc.’s policy regarding criminal background information, the attached New York Correction Law - Article 23-A and have had the opportunity to ask questions and assess information.

I attest that all of the above information is true and should evidence proving the contrary become available, my employment could be affected or terminated.

I understand that I am entitled to receive a copy of any statutory criminal background check notices and any adverse results from the state agency conducting such criminal background check pertaining to my employment application.

I authorize Unlimited Care, Inc. to perform a Criminal Background Records Verification Check.

Applicant Name*:

Email*

Date*: