Job Application              SSN Must be Supplied if Interviewed
    If No, Employment is subject to verification that you are of minimum legal age.
    If applying for a nursing position you must provide nursing certifications.
    Education
    Employment Record - List below beginning with your most recent, all present and past employment.
    Personal References (Not current employers or relatives)
                                                                                    Job applicant's agreement, certification and release of information.
    "The facts set forth above in my application for employment are true and complete; I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal if and when discovered." " I hereby irrevocably appoint any officer or administrator of Valley Care Management as my agent with full authority to request, inspect, copy and otherwise have access to the following on my behalf and in my stead to the extent that such information may relate to my past, present or future employment. "
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    1. All personal information and records now or hereafter maintained by any agency of the State of Virginia or the United States in any exiting or future information system with in the meaning of the Federal Privacy Act of 1974 and the Virginia Privacy Act of 1976 as the same may be amended from time to time.
    2. All official records maintained by any agency or public body of the State of Virginia or the United States within the meaning of the Federal and Virginia Freedom of Information Act, as the same may be amended from time to time.
    3. All records maintained by my present or past employers relating to my employment.
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    I agree to be employed on a 90 calendar days probationary period and that during this time I may be released of I may resign without any bad effect on my employment record. I agree to submit to a physical exam and drug screen whenever requested and, if employed, I agree to abide by all present and subsequently issued personnel policies and rules of Valley Care Management. In the event of employment, I understand that my employment is terminable at will for any reason.
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    Valley Care Management is an equal opportunity employer and does not discriminate on the basis of race, color, age, religion, sex, national origin, disability, veteran status, handicap or any other personal characteristic protected by Federal, State or Local Law. Applicants are not required to disclose information about physical or mental disabilities that will interfere with job performance. However they may suggest for consideration by Valley Care Management any special accommodations they believe would be appropriate to accommodate a physical or mental disability.