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RN Senior Consultant (Part-Time)
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Personal Information

Additional Information

Employment Desired

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Are you currently employed by Myers and Stauffer LC?

Have you ever been employed by Myers and Stauffer LC?

Are you legally authorized to work in the U.S. for any and all employers?

Do you now or will you in the future require work authorization or a visa to work in the US? e.g. H-1B, TN status, O-1 status, L-2S dependent status, Employment Authorization Document (EAD), OPT/CPT, or any other non-immigration status, etc.?

For example: Are you currently in the US on an H-1B, F-1, OPT/CPT, TN, J or L, or any other employer-specific non-immigrant status? Do you have an EAD tied to a nonimmigrant visa which cannot be renewed beyond a specific date? Do you have an EAD issued in connection with an application for a permanent residence?

Please identify family members or members of your household currently employed by Myers and Stauffer LC.

Are you bound by any employment agreements that would prevent you from functioning in the role for which you are applying?

What is your highest level of education completed?

Applicant Statement

I understand that should I obtain employment, I agree to conform to the rules and regulations of Myers and Stauffer LC, and its subsidiaries.  I also understand that my employment and compensation can be terminated at will (i.e. with or without cause, and with or without notice, at any time, at the option of either Myers and Stauffer LC or myself).  I understand that no manager or representative of Myers and Stauffer LC other than the President of Myers and Stauffer LC, has any authority to enter into any agreement for employment other than on an at-will basis.

I certify that, to the best of my knowledge, the answers given by me to the foregoing questions are correct and that the statements made by me in this application are correct without omission of any kind.  I understand that any false information contained in this application is cause for discharge at any time during my employment.

I understand that at a later date Myers and Stauffer LC may conduct a background check which may include, but not be limited to: a criminal check, education verification, credit check, and social security number verification. Should Myers and Stauffer LC desire to do so I will be required to provide the necessary consent and release to conduct such background checks and agree that my failure to do so will terminate the employment application process.  I understand that an offer of employment will be conditioned on a successful completion of any background check Myers and Stauffer LC chooses to conduct.

I understand that should I become employed that a condition of such employment will be the execution of a confidentiality and/or non-solicitation agreement or such other agreement as required by Myers and Stauffer LC.  Prior to my acceptance of employment I understand that I may request to review the agreement applicable to my position. 

If I am a resident of the State of California, I understand Myers and Stauffer LC collects personal information from me in connection with the application for employment which includes the following categories of personal information (PI): identifiers, personal records, professional or employment information, and inferences drawn from my PI.  I understand my PI is collected for Myers and Stauffer LC purposes, including performing services and operations related to my potential employment. For additional details or questions, please contact Myers and Stauffer LC at employeeprivacy@cbiz.com.

By my electronic application, I acknowledge I have read and agree to these terms.

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