Applicant’s Certification and Agreement



  1. Certification of Truthfulness: I represent that all of my statements in the Application for Employment (and in any materials I have submitted in support of my Application) are true and complete.  I understand and agree that if HCSSC should determine that any of my statements are false or misleading or that I withheld any requested information, I may be disqualified from employment or discharged.
  2. Employment at Will: I agree that if I am hired by HCSSC I will comply with all rules, regulations, policies, and communications directed to employees, including any changes made from time to time.  I understand that I will be free to resign my employment at any time with or without cause, and with or without prior notice to HCSSC; I also agree that HCSSC may terminate my employment at any time, with or without cause and with or without prior notice.
  3. Limitation on Claims: I agree that any claim or suit against HCSSC and/or its agents, including but not limited to claims related to my application, employment or separation from employment and claims arising under State or Federal civil rights statutes, must be brought within the following time limits or be forever barred:  (a) for lawsuits requiring a Notice of Right to Sue from the EEOC, within 90 days after the EEOC issues that Notice; or (b) for all other claims, within (i) 180 days of the event(s) giving rise to the claim, or (ii) the time limit specified by statute, whichever is shorter.  I waive any statute of limitations that exceeds this time limit.
  4. Authorization to Work: I agree that if I am selected for hire I will certify and produce documentation that I am authorized to work as required by the Immigration Reform and Control Act of 1986.
  5. Disability Accommodation: If I need an accommodation of a disability in order to perform the job for which I am applying or to complete the application process, I understand that Michigan law requires that I notify HCSSC of this need in writing within 182 days after I know or reasonably should have known of it.
  6. Drug Testing: I agree to provide HCSSC with appropriate specimens to test for the presence of drugs or other controlled substances. I understand that decisions concerning my employment will be made as a result of these tests.
  7. Physical Exam: I understand that any job offer will be conditioned on passing a physical exam.
  8. Consideration for Employment: I agree to the above terms.  I understand and agree that these terms can be revised only by a contract signed by both HCSSC and me, and that no representative of HCSSC has any authority to offer employment other than on an at-will basis as described above.  I understand and agree that, except as provided above, all compensation, benefits, programs, rules, and policies of HCSSC are subject to exception or change at any time as decided by HCSSC in its sole discretion.


I acknowledge that I have been given adequate time to read, complete, and review the Application and the Certification and Agreement; that I have read and understand the terms of the Application and the Certification and Agreement; and that I have signed the Application and the Certification and Agreement knowingly and voluntarily.


This authorization and waiver is part of my written application for employment with HCSSC.

I authorize all employers and educational institutions where I am or have been employed or enrolled, and all law enforcement agencies, to disclose to HCSSC any and all information in their possession about my employment history (including disciplinary and other matters), personal background, and/or credit background.  I hereby waive written or other notices from all such parties of their release of any such information to HCSSC.  I further authorize all educational institutions I have attended to disclose to HCSSC any and all information in their possession regarding my attendance and performance at such institution, including but not limited to:  disclosure of any diploma or degree of certification awarded; disclosure of academic information and transcripts; and disclosure of any disciplinary record.  I hereby waive written or other notice from such institution of its release of any such information to HCSSC

I understand that under Michigan’s Bullard-Plawecki Employee-Right-To-Know Act I am entitled to notice of the release of information from my personnel record, and I hereby specifically waive any such notice from any prior employer.

I release all my prior employers and educational institutions, and all law enforcement agencies, from any liability or claim relating to the release of information, records or opinions to HCSSC, or to any employment decisions made by HCSSC as a result thereof.

For purposes of this Authorization and Waiver, a photocopy of my signature shall have the same force and effect as my original signature.