APPLICANT’S STATEMENT 

Looking Glass Community Services prohibits discrimination on the basis of any characteristics protected by applicable local, state, federal law and any agency policy. 

The information I have provided in this application form, resume, or interview is true and complete. I possess the minimum qualifications outlined in the job description and I can perform the essential functions of this job. I understand that relatives shall not be employed anywhere in Looking Glass Community Services where one family member would be in a position of confidentiality conflicts, or exercising supervisory, appointment or grievance adjustment authority over the other. I have not knowingly withheld any information that would affect my application for employment. 

If any statement I made in the preceding paragraph is found to be untrue, it may be grounds for immediate dismissal. 

I understand that Looking Glass Community Services is not obligated to consider or reconsider this application at any time, and that acceptance of my application does not constitute an offer of employment. 

I give permission to Looking Glass Community Services to seek pertinent employment information from previous employers or others who may have knowledge of me. I also authorize any such person or agency to give Looking Glass Community Services any and all information concerning my previous employment. This includes, but is not limited to, an assessment of my job performance, ability, fitness and/or any other information they may have, personal or otherwise. I will not make legal claim against anyone who furnishes Looking Glass Community Services with a reference. And I fully realize that any such reference will be held in confidence and will not be made available to me, as allowed by state law. 

If employed, I hold Looking Glass Community Services harmless from any liability for future references it may provide regarding my work history.

I authorize Looking Glass Community Services, or its agent, to obtain criminal background and motor vehicle driving reports on me. 

I also authorize Looking Glass Community Services to conduct fingerprinting, if requested by State of Oregon Background Check Unit. 

If hired, I understand and agree that my employment is "at will", which means that either Looking Glass Community Services or I may terminate my employment at any time, with or without cause, and with or without notice.