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HCV Program Landlord Registration

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When necessary, note question number and use this field to provide any additional explanations.","name":"field-for-additional-explanations-with-question-numbers","subtype":"textarea","className":"d-block"},{"type":"radio-group","required":true,"label":"1.) Are you at least 18 years of age and legally eligible for work in the United States?","inline":true,"name":"1-Is-at-least-18-and-eligible-for-work-in-the-US","className":"d-block","values":[{"label":" Yes","value":"yes"},{"label":" No","value":"no"}]},{"type":"radio-group","required":true,"label":"2.) Will you work overtime when necessary?","inline":true,"name":"2-Will-applicant-work-overtime","className":"d-block","values":[{"label":" Yes","value":"yes"},{"label":" No","value":"no"}]},{"type":"radio-group","required":true,"label":"3.) Have you received a description of the job or been made aware of the essential functions of the job you are applying for?","inline":true,"name":"3--Have-you-received-a-description-of-the-job-or-been-made-aware-of-the-essential-functions-of-the-job-you-are-applying-for","className":"d-block","values":[{"label":" Yes","value":"yes"},{"label":" No","value":"no"}]},{"type":"radio-group","required":true,"label":"4.) Do you understand the job requirements and can you perform the essential functions of the job applied for?","inline":true,"name":"4-Do-you-understand-the-job-requirements-and-can-you-perform-the-essential-functions-of-the-job-applied-for","className":"d-block","values":[{"label":" Yes","value":"yes"},{"label":" No (If not, what job functions would be affected? List them above.)","value":"no"}]},{"type":"radio-group","required":true,"label":"5.) Do you need any accommodations to perform the job applied for?","inline":true,"name":"5-need-any-accommodations-to-perform-job-applied-for","className":"d-block","values":[{"label":" Yes (If yes, list the needed accommodations above.)","value":"yes"},{"label":" No","value":"no"}]},{"type":"radio-group","required":true,"label":"6.) Are you on layoff and subject to recall?","inline":true,"name":"6-Are-you-on-layoff-and-subject-to-recall","className":"col-md-6","values":[{"label":" Yes","value":"yes"},{"label":" No","value":"no"}]},{"type":"radio-group","required":true,"label":"7.) Were you previously employed with us?","inline":true,"name":"7-Were-you-previously-employed-with-us","className":"col-md-6","values":[{"label":" Yes","value":"yes"},{"label":" No","value":"no"}]},{"type":"radio-group","required":true,"label":"8.) Do you have any relatives working for us?","inline":true,"name":"8-Do-you-have-any-relatives-working-for-us","className":"col-md-6","values":[{"label":" Yes (Please list names and relationship above.)","value":"yes"},{"label":" No","value":"no"}]},{"type":"radio-group","required":true,"label":"9.) May we contact your present employer?","inline":true,"name":"9-May-we-contact-your-present-employer","className":"col-md-6","values":[{"label":" Yes","value":"yes"},{"label":" No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Employment History","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Please list below your last three employers beginning with the most recent.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"1. Most Recent Employer","className":"d-block"},{"type":"text","required":true,"label":"1a. 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Include date granted, name of organization, and any other relevant information.","name":"list-of-professional-licenses-designations-certifications-etc","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Applicant's Certification Agreement/Release of Information","className":"d-block"},{"type":"paragraph","subtype":"p","label":"1. In making this application for employment, I do hereby authorize a review of and full disclosure of all records concerning myself to any duly authorized agent of the Housing Authority of Florence, whether the said records are of a public, private, or confidential in nature through a background check. I also certify that any person(s) who may furnish such information condemning me shall not be held accountable for giving this information, and I do hereby release said person(s) from any and all liability which may be incurred as a result of furnishing such information. A photocopy of this statement will be valid as an original thereof, even though the said photocopy authorizes past employers, all references and other persons to answer all questions concerning my ability, character, reputation and previous employment records. I release all such persons from any liability that might result from providing this information.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"2. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment regardless of when or how discovered.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"3. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"4. If I am offered and accept a position, I agree to conform to all existing and future Housing Authority rules and regulations and I understand that the Housing Authority reserves the right to change wages, hours, and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"5. As a condition of employment, I hereby agree to provide my driving record.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"6. I also will provide a criminal background history which may be investigated and authorize the release of the results to the Housing Authority and/or authorize a criminal background check be conducted.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"7. As a condition of employment, I hereby agree to submit to a drug screen test; and that my employment is contingent upon passing a substance abuse screening.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"8. I also understand that my employment is subject to an initial orientation period and verification that age and citizenship/visa status meet legal requirements.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"9. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment, I certify that I understand all parts of it and have answered all questions completely and fully.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"10. Failure to sign this consent discontinues the employment process.","className":"d-block"},{"type":"text","required":true,"label":"Applicant Signature (by typing your name, you are signing this form)","name":"applicant-signature","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Signature Date","name":"Signature-Date","className":"col-md-6"}]

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