EMPLOYMENT APPLICATION We are an equal opportunity employer, dedicated to non-discrimination in employment on the basis of race, color, age, sex, national origin, disability or veteran status.

FACULTY APPLICATION We are an equal opportunity employer, dedicated to non-discrimination in employment on the basis of race, color, age, sex, national origin, disability or veteran status.

Application for Employment Greene County is an equal opportunity employer. Qualified applicants are eligible to compete for positions without regards to race,

Check all of the programs that apply: Medicaid hawk-i Facility To be completed by the client or the client’s personal representative I ask the Department of Human Services give me access to the following health information about me or members of my family. I understand that I will get the information or a denial of my request in 30 days if the information is easily available. If the information is not easily available, I will get it in 60 days unless the Department writes to me giving me the reasons for needing more time (up to 30 more days). I understand that there may be a charge for making a copy of this information and that I will be told of the charge before I receive the information. I understand that there are certain types of health information that the Department cannot release by law, such as psychotherapy notes. I understand: • If my request is denied because a medical professional believes the information may cause harm to me or to someone else, I can ask that another medical professional review the decision. If the second medical professional still denies my request, I can appeal that decision. • If my request is denied for any other reason, I can appeal the decision.

APPLICATION

APPLICATION

Financial risks can be enormous if the right information falls into the wrong hands. Because of identity theft concerns, more and more organizations are adopting security policies to better protect information that is considered private and personal, such as credit card and Social Security numbers

Shinu VergheseThis page has been left blank for double-sided copying. Contract Number:

Once an investigator decides to pay a research participant, a number of points need to be considered. First and foremost, participant payment raises ethical issues pertaining to the requirement for voluntary participation and the individual’s ability to make informed choices about research

Have you ever been convicted of a felony? Yes No If yes, explain The following should accompany this application or should be sent immediately: 1. A complete and official transcript of all university work 2. If available, a dossier from your placement office Under the Immigration Reform and Control Act of 1986, the University is required to verify a new employee’s identity and eligibility to work in the United States. Employment is conditioned upon such verification. Sam Houston State University Is An Equal Opportunity/Affirmative Action InstitutionEDUCATIONAL BACKGROUND Indicate secondary school and complete college record. If work is in progress toward a degree, indicate degree sought and anticipated date of conferral. Mark anticipated date with an asterisk.