Substance Use Disorder / Co-Occurring Outpatient Therapist (LISW or LMHC)

I hereby certify that, if hired, I will disclose any limitations I have that may impact my ability to do the job. I understand that I may also be required to undergo a pre-employment or post-employment medical exam by the VFCMHC' designated health practitioner.

Notification and authorization to contact references and conduct background investigation

I understand that I may be subject to a background check, and hereby authorize Vera French Community Mental Health Center, or any of its affiliates, to investigate my background to determine any and all information of concern as to my record, whether the same is of record or not, and I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information.

Additionally, you are hereby authorized to make any investigation of my personal history, educational background, military record, motor vehicle records, criminal records, and credit history through an investigative or credit agency or bureau of your choice. I authorize the release of this information by the appropriate agencies to the investigating service. I authorize and give permission for the individuals listed as references to provide written information and/or verbally discuss my background with Vera French Community Mental Health Center, or any of its affiliates.

This authorization, in original or copy form, shall be valid for this and any future reports and updates that may be required. I understand that passing the background check is a condition of employment. A negative background check can be grounds for dismissal, even if an offer has been made to me and I have been hired.