I, the undersigned applicant, certify and affirm that, to the best of my knowledge and belief: I ("have" or "have not", as applicable) ad a case of abuse, neglect, mistreatment or exploitation substantiated against me.
As a condition of submitting this application and in order to verify this affirmation, I further release and authorize ACT the Tennessee Department of Intellectual and Developmental Disabilities and the Bureau of TennCare to have full and complete access to any and all current or prior personnel or investigative records, from any party, person, business, entity or agency, whether governmental or non-governmental, as pertains to any allegations against me of abuse, neglect, mistreatment or exploitation and to consider this information as may be deemed appropriate.
This authorization extends to providing any applicable information in personnel or investigative reports concerning my employment with this employer to my future employers who may be Providers of DIDD services.