Substance Use Disorder Counselor | Job Code: 21-014

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Are you able to perform the essential function of the position for which you are applying, either with or without reasonable accommodations

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I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements verified by The Lundquist Institute unless I have indicated to the contrary.  I authorize the immediate supervisors listed above, as well as all other individuals whom The Lundquist Institute may contact, to provide The Lundquist Institute with any and all information concerning my previous employment, education and qualifications for employment (except salary history).  Further, I release all parties and persons from any and all liability for any damages that may result from furnishings such information to The Lundquist Institute as well as from any use or disclosure of such information by The Lundquist Institute or any of its agents, employees, or representatives. 


In consideration of my employment, I agree to conform to the rules and standards of The Lundquist Institute.  I further agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of The Lundquist Institute.  I understand that no employee or representative of The Lundquist Institute, other than its President & CEO, has the authority to enter into any agreement for employment for any specified period of time, or to make any express or implied agreement contrary to the foregoing.  Further, the President & CEO of The Lundquist Institute may not alter the at-will nature of the employment relationship or enter into any employment agreement for a specified time unless the President & CEO and I both sign a written agreement that clearly and expressly specifies the intent to do so.  I agree that this shall constitute a final and fully binding integrated agreement with respect to the at-will nature of my employment relationship and that there are no oral or collateral agreements regarding this issue.


I understand that as a condition of employment I may be required to take a post-offer/pre-employment physical examination, which may include an alcohol and drug test.  I further understand that at any time during my employment, I may be required to a take a physical examination which may include an alcohol and drug test if management reasonably suspects a condition exists that will prevent me from performing my job in a manner that does not endanger my own health or the safety and health of others.  I authorize all providers of health care who examine me to disclose to The Lundquist Institute, or its agents, all medical information revealed during such examinations.  In the event that I have a disability that will affect my ability to take the physical examination, I will so inform The Lundquist Institute so that a reasonable accommodation can be made. The Lundquist Institute reserves the right to require medical documentation concerning the need for accommodation.


I also understand that all offers of employment are conditioned on The Lundquist Institute’s receipt of satisfactory responses to reference requests and the provision of satisfactory proof of my identity and legal authority to work in the United States.


I understand that this application is applicable only for the position for which I’ve instantly applied and if I wish to be considered for an alternate position, it will be necessary to fill out a new application.


I hereby acknowledge that I have read the above statements and understand them.  I certify that I, the undersigned applicant, have personally completed this application.  I declare under penalty of perjury that the facts contained in the application (or any resume or other documents submitted) are true and complete to the best of my knowledge. 


I understand that any intentional misrepresentation, falsification, or omission of information on this application may result in my failure to receive an offer and will be justification for my dismissal from employment, if discovered at a later date.

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I certify that all of the information in this application is true and correct as of this date.

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