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Director of Finance, Controller
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Personal Information

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Additional Information

Desired Employment Type

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Are you over 18 years of age?

Are you legally eligible to work in the United States?

Do you now, or will you in the future, require sponsorship to work in the US?

Other than a parking ticket, have you ever been convicted of a crime? If Yes, please provide date, location and explain.

Have you ever been excluded from participation in Medicare, Medicaid or another Federal Health Care Program? If Yes, please provide offense, date and explain.

OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.

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Education History

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Candidate Sign Off

I certify that the information provided in this Application for Employment is true and correct, and that no attempt has been made to conceal pertinent information. I understand that all statements made are open to investigation by Sheltering Arms Institute, and that if any information is found to be false or misleading, will subject me to dismissal at anytime during the period of my employment, and I agree to hold Sheltering Arms Institute and persons named herein blameless in that event. I agree that if I am offered a job, I will submit to a physical examination, including drug screening, and a criminal history background check, and that my employment will be conditioned upon the results. Further, I understand and agree that my employment is for no definite period of time and may be terminated at any time by the company.

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