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Thank you for your interest in Palolo Chinese Home!

Palolo Chinese Home is an equal opportunity employer. Applicants are considered for positions without discriminating on the basis of race, color, religion, national origin, ancestry, sex (including gender identity or expression), sexual orientation, age, disability, genetic information, marital status, arrest and court record, credit history, domestic or sexual violence victim status, veteran/military status, citizenship status, or any other characteristic protected by federal, state, or local law.

APPLICATION FORM

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PRE-PLACEMENT DRUG TESTING

 

Palolo Chinese Home is committed to providing quality resident care and a safe, healthy and productive work environment through a drug and alcohol free workplace. All offers of employment are contingent upon the applicant submitting to a drug test. Palolo Chinese Home will not hire any individual who fails to pass the pre-placement drug test.

I understand that as required by Palolo Chinese Home, all applicants must be tested for controlled substances and illegal drugs as a pre-condition of employment.

I understand that if I fail to report to the designated collection site within twenty-four (24) hours from the time of notification, I will be disqualified for any and all employment which may be available now for which may become available in the future.

I consent to the urine sample collection and testing for controlled substances, such as amphetamines (including crystal methamphetamine), barbiturates, benzodiazepines, cocaine, marijuana (THC), opiates (including heron, phencyclidine (PCP).

I will disclose to Palolo Chinese Home in writing all controlled substances that I am taking that have been prescribed for me by my physician. I understand that a positive test result for controlled substances which have not been prescribed for me by my physician will render me unqualified for employment at Palolo Chinese Home.

Negative and positive results will be reported to Palolo Chinese Home. If the results are positive, the controlled substance will be identified.

I understand the above conditions and hereby agree to comply with them.

 

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AUTHORIZATION TO OBTAIN CONSUMER REPORTS OR INVESTIGATIVE CONSUMER REPORTS

 

I understand and agree that Palolo Chinese Home may obtain one or more consumer report(s) and/or investigative consumer report(s) about me, which may include, among other things, information as to my character, general reputation, personal characteristics and mode of living. Information for this report may be obtained through personal interviews with my former employers, friends, acquaintances or others who may have knowledge concerning any such information.

I further understand that the information contained in the consumer report and/or investigative consumer report will be used for the purpose of evaluating me for employment.

I understand that I have the right to request in writing a complete and accurate disclosure of the nature and scope of the consumer report or investigative consumer report which is the subject of this authorization.

I acknowledge that I have been provided with a copy of “A Summary of Your Rights Under the Fair Credit Reporting Act.”

I also specifically give Palolo Chinese Home and its authorized agent(s) permission to request information concerning records of my conviction of a crime in any state or federal jurisdiction. I understand that no criminal conviction check regarding me will be obtained by Palolo Chinese Home until I am given a conditional offer of employment.

 

List other cities you have lived in the past 7 years

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A Summary of Your Rights Under the Fair Credit Reporting Act