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An Equal Opportunity Employer
I certify that all the foregoing statements are complete, true and correct. In consideration of the employment sought, I hereby authorize South Mississippi Mental Health Center to investigate and request former employment to furnish any information concerning me, and I release them from any and all liabilities or damages due to furnishing truthful information.
I hereby agree, on request to undergo physical examination by a physician designated by the South Mississippi Mental Heatlh Center at the South Mississippi Mental Heatlh Center's expense and to also undergo future physical examinations that the South Mississippi Mental Heatlh Center may require for continued employment and to be photographed. I further agree that I will submit to pre-employment drug testing, and if I am hired, I understand that I may be subject to future drug testing pursuant to policies of South Mississippi Mental Heatlh Center. I understand and agree to a pre-employment review of my motor vehicle record and, if I am employed and operate County vehicles or other similar equipment, to a periodic review of my motor vehicle record. I agree to conform to the rules and regulations of the South Mississippi Mental Heatlh Center and understand that my employment and compensation may be terminated with or without cause and with or without notice at any time at the option of either the South Mississippi Mental Heatlh Center or myself. I further understand that no employment contract exists or is created by the implementation of any South Mississippi Mental Heatlh Center personnel policies and that no representative of the South Mississippi Mental Heatlh Center has authority to enter into an agreement with me for employment of any specified period of time, or to make any agreement with me; contract to the foregoing; and also that any employee of South Mississippi Mental Heatlh Center may be terminated at any time with or without cause.
In addition, I understand that this employment application is not an employment contract. I understand that misrepresentation or omission of facts called for is cause for rejection of the application, or dismissal, if discovered after I am hired.
We are a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows and are hereafter referred to all together as “protected veterans”.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive and positive recruitment efforts we undertake pursuant to VEVRAA.
Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended.
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
You are considered to have a disability if you have a disability if you have a physical or mental impairment or medical condition that is substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
We are an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, color, gender, national origin, ancestry, religion, physical or mental disability, age, veteran status, sexual orientation, gender identity or expression, marital status, pregnancy, citizenship, or any other factor protected by anti-discrimination laws.
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodations include making a change to the application process or work procedures, providing documents in alternate format, using a sign language interpreter, or using specialized equipment.
Section 503 of the Rehabilitation Act pf 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp
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