I hereby authorize Aviva Children’s Services to verify any information I have provided, and I further authorize any of the named schools,
companies or persons listed to provide any information about me contained in their records. My signature also releases Aviva Children’s
Services, its officers, agents, and employees from liability for such disclosure. If hired, I understand I will be asked to provide a copy of
my most recent motor vehicle record. A request also may be made for a copy of my high school diploma or GED, or university degree if
If I become employed by Aviva Children’s Services, I understand that it will be necessary for Aviva Children’s Services to have a copy
of applicable documents the employer determines are sufficient to prove the applicant's right to work in the U.S.
Aviva Children’s Services is a drug-free workplace. Eligible candidates are required to undergo drug and/or alcohol testing.
Circumstances may arise during employment that make it necessary, in the judgment of the employer, for an employee to take random or
job-related drug or alcohol examinations, which would be conducted at the employer's expense. Acceptance of employment constitutes
the applicant's agreement to submit to such an examination as a condition of continued employment, if requested to do so b y the
I understand that, should I be hired for the position for which I am applying, or any subsequent position, either Aviva Children’s Services
or I may terminate the working relationship at any time and for any reason or no reason at all. I understand that no contract may be made
orally, regardless of the reliance of the employee to such statements made by any manager at Aviva Children’s Services. I further
understand that, if employed, my wages and position may change, but my status as an employee-at-will will never change during my
employment. Completion and/or submission of this application does not constitute an offer of employment.
I certify that all of the answers and statements I made on this application or any supplement thereto are true and correct to the best of my
knowledge or belief. I understand and agree that any misrepresentation, falsification, or omissions by me in this application may be of
sufficient cause for cancellation of the application and/or immediate separation from Aviva Children’s Services if I have since been
employed. I agree to immediately notify my employer should I be convicted of a felony or any crime involving dishonesty, breach of
trust, federally controlled substance, sexual misconduct, abuse or violence, while my application is pending or during my period of
employment if I am hired. I understand that, if hired, I am obligated to meet the terms of current and future Aviva Children’ s Services
policies. I further certify that I have not been discharged from employment for misconduct or moral turpitude.
Electronic Signature: *
Date Signed: *