Rev. 2020/11/04 6/6
Applicant’s Statement
Applicant’s StatementApplicant’s Statement
Applicant’s Statement
Important – Please Read, Initial, Sign & Date
This application for employment will only be considered for the position(s) listed on the front of the application;
copies of this application will be accepted for multiple positions. Any applicant wishing to be considered for
further employment must submit a new application for the position desired. As part of the application process, we
will verify information on your application form. If you report false, inaccurate or misleading information, we will
reject your application or will terminate your employment if we discover such information after the date of hire.
Post-Offer Criminal Background Check: Should a search of public records be conducted by internal
personnel employed by the Agency or by a contracted third party, I am entitled to copies of any such public
records obtained by the Agency unless I mark the check box below. If I am not hired as a result of such
information, I am entitled to a copy of any such records even if I have checked the box below. “Public records” are
defined by California state law as records documenting an “arrest” indictment, conviction, civil judicial action, tax
lien, or outstanding judgment.” (Civil Code section 1786.53) Any public records request conducted by internal
personnel employed by the Agency will only be used to the extent allowed by federal, state, or local law. Clicking
the box constitutes agreement with the following statement:
I waive receipt of a copy of any public record described in the paragraph above.
Post-Offer Medical Exam: For certain positions (e.g. Laborer, Field Worker, Maintenance), we use a
medical exam as part of our hiring process. Any offer of employment is conditional upon you passing the post-
offer medical exam. The exam occurs after the job offer but before the performance of any job duties. You will be
asked to sign a separate authorization to release the results of the exam from our chosen health care provider. If
you do not pass the post-offer medical exam due to a disability, we will work with you to determine if a reasonable
accommodation would permit you to perform the required job duties. If we cannot find a reasonable
accommodation that would be effective, we will withdraw the offer of employment. We treat all medical data and
information from the exam as a confidential medical record as required by law
.
Clicking on a box constitutes agreement with the correlated statement:
I understand that neither this document, nor any offer of employment from the employer, constitutes
an employment contract unless the employer and employee in writing execute a specific document to
that effect.
At-Will Employment – I acknowledge that if hired, I will be an at-will employee. This means that
RCAA or I may end my employment at any time and for any reason. I understand that no representative
of the company, other than the Executive Director independently (or their designee), and/or the Board
of Directors has the authority to change the terms of an at-will employment and that any such change
can occur only in a written employment contract.
I am able to perform the essential functions of the job for which I am applying, either with or without
reasonable accommodation.
I authorize any representative of RCAA to thoroughly investigate my background, including, but not limited to, my
references, educational record and work history. This information includes, but is not limited to, my work achievements,
performance, attendance and disciplinary history. I authorize and direct all of my former schools, employers, and any
other individuals that possess information about my background, to release such information about me upon request by
a representative of RCAA, regardless of any prior direction to the contrary that I may have given. I also authorize
disclosure to RCAA of all transcripts, reports, letters and other education or work records, without prior notice to me. I
release all schools, past and present employers, and all other individuals and entities from any and all liability for damage
of whatever kind which may at any time result to me because of compliance with this authorization and request to release
information.
I declare that all statements and answers in this application are true and complete and agree that any untruth, misleading
answer, omission, concealment or failure to answer any question fully, completely and accurately will be grounds for
terminating my employment. I agree that if employment is offered to and accepted by me, it is mutually understood and
agreed that any employment is not confined to a fixed term and may be ended by either party without prior notice, unless
otherwise affected by written company policies.
Name: Date:
Clicking on this box constitutes agreement with the preceding two paragraphs:
