Authorization for Employment Verification

Golden Horizons ElderCare Services, Inc.

251 Main St. #201
Old Saybrook, CT 06475

Contact: (860) 388-1788

Please read form carefully and select yes or no. Then submit.












Authorization for Employment Verification

I authorize Golden Horizons or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation.

I authorize and consent to, without reservation, any party or agency contacted by Golden Horizons to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to Golden Horizons or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action, which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability, Golden Horizons, and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

If hired by Golden Horizons, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by the Company. I also understand Golden Horizons employs only individuals who are legally eligible to work in the United States.

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE. I UNDERSTAND THAT BY SELECTING YES, I GIVE MY CONSENT FOR GOLDEN HORIZONS TO VERIFY MY STATEMENTS AND ALL PREVIOUS EMPLOYMENT.


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