How did you hear about this job opening?
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s)
was/were committed, sentence(s) imposed, and type(s) of rehabilitation, include whether felony or misdemeanor, and
all deferral arrangements. (Conviction will not necessarily disqualify applicant from employment)
If yes, please provide Company
name and details:
PLEASE READ CAREFULLY
APPLICATION FORM WAIVER
In exchange for the consideration of my job application by Northwest Indiana Community Action (hereinafter
called “the Company”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship,
either in the position applied for or any other position, and regardless of the contents of employee handbooks,
personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other
Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to
remain an employee of the company, or otherwise to change in any respect the employment-at-will
relationship between the Company and me, and that relationship cannot be altered except by a written
instrument signed by the President/CEO of the Company. Both the undersigned and the Company may end
the employment relationship at any time, without specified notice or reason. If employed, I understand that the
Company may unilaterally change or revisit benefits, policies and procedures and such changes may include
reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the
misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.
I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated),
references, law enforcement agencies and others, and hereby release the Company from any liability as a
result of such contact.
I also understand that (1) the Company has a drug and alcohol policy that provides for testing after
employment; (2) consent to and compliance with such policy is a condition of my employment; and (3)
continued employment is based on the successful passing of testing under such policy. I further understand
that continued employment may be based on the successful passing of job-related physical examinations.
I understand that; in connection with the routine processing of my employment application, the Company may
request from a consumer reporting agency and investigative consumer report including information as to my
credit records, character, general reputation, personal characteristics, and mode of living. Upon written request
from me, the Company, will provide me with additional information concerning the nature and scope of any
such report requested by it, as required by the Fair Credit Reporting Act.
I further understand that my first 90 days of employment with the Company shall be introductory, and further
that at any time during the introductory period or thereafter, my employment relationship with the Company is
terminable at will by either party, with or without cause.
