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Provide if you prefer to receive information via email.
Please provide any current professional licenses, certifications, or registries you may hold:
Please provide all locations where you have resided for past seven (7) years, starting with your current residency.
Maine applicants or employees only: Under Chapter 210 Section 1314 of Maine Revised Statutes, you have the right, upon request, to be informed within 5 business days of such request of whether or not an investigative consumer report was requested. If such report was obtained, you may contact the Consumer Reporting Agency and request a copy.
Massachusetts applicants or employees only: If you ask, you have the right to a copy of any background check report concerning you that the Company has ordered. You may contact the Consumer Reporting Agency for a Copy.
Washington State applicants or employees only: You have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of the investigation we requested. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
I have read and understand the above information and assert that all information provided by me is true and accurate.
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1 The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.This information is necessary for the proper processing of a consumer report.Nevada Private Investigator License # 1618
If you want to volunteer and take care of sick patients, then you can be part of the St. Mary's Medical Center volunteer...
Please complete a volunteer disclosure and authorization form if you are interested in volunteering with us.