Use this form to Contact Us & Set an Appointment to See Our Western Oklahoma Senior Care Facilities
Your Name (required)
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The parties agree that these agreements may be electronically signed. The parties agree that the electronic signatures appearing on such agreements are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
Consent to be contacted:
By providing the information above, I am providing an electronic signature expressly authorizing Corn Heritage Villages, its affiliates, employees, or direct contractors to contact me at any address, telephone number or email address I have provided to communicate with me regarding my application for employment with Corn Heritage Villages, or other employment opportunities. I agree that Corn Heritage Villages, its affiliates, or third parties, including, but not limited to, Corn Heritage Villages, cornheritage.org, or others, may use SMS (text) messages, automatic telephone dialing systems or pre-recorded messages in connection with calls made to any telephone number I entered, even if the telephone number is assigned to a cellular telephone service or other service for which the called party is charged. I understand that Corn Heritage Villages may record telephone conversations I have with its representatives for quality control and training purposes and I consent to the recording of those calls. I understand that agreeing to these terms is not a requirement of applying for a job with Corn Heritage Villages. I understand that I may apply in person at Corn Heritage Villages’ physical location(s).
This certifies that the application was completed by me, and that all entries on it and information in it are true to the best of my knowledge. In connection with Corn Heritage Villages considering me for employment, continued employment promotion or reassignment, I authorize Corn Heritage Villages and/or its agents to obtain a consumer report which may include information on my character, general reputation, personal characteristics, and mode of living from public record sources or through personal interviews with previous employers or associates. Public record check may include, but not be limited to, criminal or felony background information and sex offender’s registry. I understand that a consumer reporting agency investigation may include obtaining a motor vehicle license and understand that we will conform to the Driver Privacy Protection Act. The applicant is required for the motor vehicle to provide a consent form and a valid photo I.D. before obtaining the record. Our company will retain the consent form and the results for a period of five (5) years.
I authorize, without reservation, any person or entity contacted by Corn Heritage Villages or its agents to furnish the above-stated information and I release any such person or entity from any and all liability for furnishing such information. I further release Corn Heritage Villages, its affiliates, officers, employees, agents, or contractors from any liability and responsibility arising from the preparation of said report. I understand that false and/or misleading statements or information made on this authorization, or made during the employment process, will disqualify me from consideration for employment or result in immediate discharge if employed.
You have the right, upon written request, to receive a written description of the nature and scope of the investigation requested and a written summary of your rights under the Fair Credit Reporting Act.
By submitting this form, you are agreeing to these terms and hereby stating that “I swear and affirm that everything in this application is true and correct. I understand that Corn Heritage Villages, reserves the right to refuse to hire me or to take disciplinary action up to and including discharge if it discovers that I have falsified any of the information in this application. Further, I consent to the background checks described in this application.”
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