Teara Coleman’s Employment Application

Application Date: 10/12/2023

Job Title: Youth Care Professional

Job Location: Williamsville

Personal Information

First Name: Teara

Last Name: Coleman

Email: ad5bml@r.postjobfree.com

Contact Information

Cell Phone: +1-716-***-****

Address: 77 Mercer Ave

City: Buffalo

State: NY

Postal Code: 14214-1821

Application Questions

Do you have a legal right to work in this country? Yes Are you at least 18 years of age? Yes

Do you have a current valid New York State Driver's License? Yes Have you ever been convicted a felony or misdemeanor in New York State or any other jurisdiction? Note: Information regarding conviction record will not necessarily bar applicant from employment but will be considered in light of duties related to position sought. No

READ FULL QUESTION BEFORE REPLYING: If you answered YES to the above questions list any and all types of conviction(s) and date(s). If you answered NO please type "N/A". Full answers are required. Any omissions or falsification of this application may result in disqualification from consideration for employment or dismissal from employment. N/A

Have you ever been excluded from participating in any federally funded health care program, including Medicare and Medicaid? No

What type of position are you looking for? Full-Time, Part-Time, On Call/Per Diem Have you received services from Gateway-Longview in the past 12 months? No Have you ever previously applied for a position with Gateway-Longview? No If yes, when did you last apply? n/a

Have you ever previously been employed by Gateway-Longview or New Directions Youth & Family Services? No If yes, please list previous dates of employment. n/a Do you have any relatives employed by Gateway-Longview? No If yes, please list their name(s): n/a

How did you hear about the position you are applying for? Indeed If Other or Current Employee, please include name: n/a

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Education History

School Name: Bryant and Stratton college

Qualification Type: Associate's Degree

Major / Area of Study: Medical Assistant

Qualification Status: Incomplete / Qualification Not Earned Currently Attend? n/a

Have you received at least a High School Diploma or equivalent? Yes School Name: n/a

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Employment History

Job Title: Production

Employer Name: Acara

Currently Employed? n/a

Start Date: 09/05/2022

End Date: 02/01/2023

May we contact your current employer? n/a

If no, please explain: n/a

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Background Experience

In the space provided below, describe any background experiences, specialized training, and skills related to the position you have applied for that makes you a good candidate for this job. n/a I acknowledge that I have read and understand the below Terms and Conditions for employment with Gateway- Longview. In addition, I certify that the information I have provided on this application and its attachments is true and correct to the best of my knowledge and that no attempt has been made by me to conceal any pertinent information.Terms and Conditions I hereby authorize Gateway-Longview to contact any of the references or employers I have provided above for purposes of obtaining any and all information concerning my previous employment and any pertinent information regarding my background, performance history and professional qualifications. I hereby release Gateway-Longview and its representatives and any former employer or reference from any liabilities, damages, claims, charges or causes of action arising out of or in any way related to any information they seek or provide in connection herewith.I understand that if I am given a conditional offer of employment, additional screening prior to hire may include the following: a physical exam, drug screen, criminal background check, DMV check, social security number verification, reference checks and clearance through the Sex Offender Registry Information Line of NYS, the NYS Central Register of Child Abuse and Maltreatment, the NYS Justice Center Vulnerable Persons Central Register and the NYS Office of Medicaid Inspector General. I hereby consent to these screens and understand that such offer is conditioned upon satisfactory results of the screenings as listed above. In addition, I understand the refusal to submit to any of the screenings will result in my conditional offer of employment being rescinded.I hereby certify that the information I have provided on this application and its attachments is true and correct to the best of my knowledge and that no attempt has been made by me to conceal any pertinent information. I understand that any false statement, misrepresentation or omission of material facts given in my application and its attachments or given during any interviews with Gateway-Longview may constitute grounds for denial of employment or subject me to termination at any time during my employment.I understand that nothing contained in this application or conveyed during any interview which may be granted is intended to create an employment contract and shall not alter the “at will” nature of my contemplated employment with Gateway- Longview, which means, subject to any collective bargaining agreement, I may resign at any time and Gateway- Longview may discharge me at any time with or without cause. I understand that any oral or written statements to the contrary are hereby expressly disavowed and should not be relied upon by me. Acceptance: Yes

By checking this box, you acknowledge and consent to terms of the privacy policy which applies to the applicant tracking service being offered by Paycor on behalf of Gateway-Longview, Inc.. The privacy policy offers an explanation of how and why your data will be collected, how it will be used and disclosed, how it will be retained and secured, and what legal rights are associated with that data (including the rights of access, correction, and deletion). The policy also describes legal and contractual limitations on these rights. The specific rights and obligations of individuals living and working in different areas may vary by jurisdiction. I have read and agree to this statement

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