Address

Consent*

By typing your name and date below you are agreeing to the following statement: To the best of my knowledge the information contained on this application is true. I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and this company for either employment or the provision of benefits and further understanding that if an employment relationship subsequently is established, I will have the right to terminate my employment at any time and the company will have a similar right. In addition, I understand that no promise, representation or agreement contrary to the forgoing is binding on the company unless it is made in writing and signed by me and an authorized representative of the company.

Consent*

By typing your name and date below you are agreeing to the following statement: I understand that I am applying for a position to work at Putnam County Comprehensive Service, Inc. and acknowledge that the burden of providing my qualifications is at all times upon myself. I further understand that an investigation of my background, character, and work history will be completed prior to employment. This authorization is given freely and voluntarily waiving my any disclosure of information under the Privacy Act.