Employment Application

We consider applicants for all positions without regard to race, color, religion, creed, gender,
national origin, age, disability, marital or Veteran status, or any other legally protected status.

APPLICANT INFORMATION







Do you have the legal right to work in the U.S.?*
Have you ever worked for this Company or Centers for Specialty Care?*
Do you have any relatives employed at Centers Plan for Healthy Living?*

EDUCATION

 
 
Did you graduate?
 
 
 
 
Computer Skills (check all that apply):
 

MILITARY SERVICE

CURRENT EMPLOYMENT

PREVIOUS EMPLOYMENT

PROFESSIONAL LICENSES/CERTIFICATIONS

INVESTIGATIONS

Are you the subject of a pending action or investigation involving fraud or abuse in Medicaid, Medicare or other Federal health care programs?*
 
Have you ever been sanctioned as a result of alleged Medicaid or Medicare fraud or abuse?*
 

DISCLAIMER SIGNATURE:

I certify that the information provided in this Application is accurate and complete to the best of my knowledge. I understand that false or misleading information if verified may result in disqualifying my application or result in termination if CPHL employs me. I also understand that the offer and condition of employment is contingent upon the successful completion of a post-offer background check and screening to include Healthcare Sanctions, Criminal Record and Sex Offender Registry checks, Employment Verifications and Professional Licenses (if applicable) and Drug Screening. I understand that my employment is not governed by any written or oral contract and is considered “at will”.

ACKNOWLEDGED AND AGREED TO:

VOLUNTARY INFORMATION

 
This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company.
 
Gender: