Confidential Application

Christian Scientists-in-Residence

Our mission statement:

"Tenacre Foundation is a Christian Science nursing ministry expressing God, Love

— our mission is to heal"

Tenacre’s Christian Scientists-in-Residence program invites Christian Scientists who are members of The Mother Church to join a Christian community bound by their commitment to the practice of Christian Science and their active participation in Tenacre’s mission and ministries. Tenacre’s resources and supportive environment encourage residents to continue their on-going study and practice of Christian Science as they continue to fulfill their own individual spiritual ministry.

(Please Answer or Notate Each Question)

Financial Considerations:

A monthly flat-rate charge is billed in advance, and is due by the fifth of the month. This rate will be shown on your signed agreement, and lists amenities included at no additional charge.

If you are not handling your own finances, please indicate who will be paying your Tenacre bills and where to send them:

Christian Science Practitioner:

It is our expectation that you will be praying for yourself on a daily basis and will be engaging a Christian Science practitioner to work for you as needed throughout your residency at Tenacre.

Please read carefully the following declaration and sign at the bottom of the page. Your signature certifies that you understand and accept the conditions of admission.

      • I am a practicing Christian Scientist and rely wholly upon God for healing.

      • I understand that Tenacre does not guarantee life care. If I am unable to live independently and wish to be admitted to one of Tenacre’s Christian Science nursing settings, I must apply through Tenacre’s Christian Science Nursing Services’ admission process.

      • I understand that the monthly charges are due by the 5th of each month and will provide for prompt payment of bills, including special services, long distance phone calls, and any special purchases made at my request.

      • I understand that Tenacre is not responsible in any way for my valuables or personal property.

      • I agree to comply within 30 days if Tenacre requests that my stay be terminated or requests that I move to another apartment.

      • I agree to give a 30 day notice if and when I decide to move from Tenacre.

Please sign this application only after carefully reviewing the above considerations. Your signature indicates that the information you have supplied is accurate, that you understand the considerations, and that your desire is to reside at Tenacre and to participate in its mission and ministry.

Please provide the names and telephone numbers of three references who are not related to you, are well-acquainted with you, have knowledge of your behavior in the past, and can describe your demeanor. One should be a Christian Science practitioner.

Tenacre may obtain investigation reports about an applicant in connection with an application for admission into the Christian Scientists-in-Residence program. Tenacre may also obtain such reports at any time during an admitted applicant’s participation in the program. Information gathered through such investigations may be used in determining whether the applicant will become or remain a resident at Tenacre.

An investigation report may include information concerning creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and/or mode of living. Examples of investigation reports include, but are not limited to, criminal background reports, motor vehicle driving records, credit histories, reference checks, verification of education or past employment, and investigations into theft, fraud, harassment and workplace violence. A program applicant has the right to request in writing, within a reasonable period of time, a complete disclosure of the nature and scope of an investigation involving personal interviews.

Because errors can occur, an applicant deemed ineligible for residence as a consequence of an investigation will receive notice of this fact. Tenacre accepts no responsibility for the accuracy of information received from third parties and is under no obligation to test the accuracy of such information before making a decision on admission to the program.

Your signature below acknowledges that you have read and understand the above disclosure.

This Notice and Disclosure is made pursuant to the federal Fair Credit Reporting Act (FCRA). The FCRA is designed to promote the accuracy, fairness, and privacy of information maintained in the files of a Consumer Reporting Agency (CRA). Most CRAs are credit bureaus that gather and sell information about consumers – such as whether a consumer pays bills on time or has filed bankruptcy – to credit, employers, landlords, and other business. Because employee background checks sometimes use information from CRAs, the FCRA is sometimes applicable to employers. The complete text of the FCRA, 15 USC Section 1681-1681u, and a description of a consumer’s rights under the FCRA are available at the Federal Trade Commission’s Web site http://www/ftc.gov.

I hereby authorize Tenacre to obtain any investigation reports on me in connection with my application for admission into the Christian Scientists-in-Residence program and/or at any time during my participation in the program if I am accepted. I understand that this report will be used to perform a background check which may be used in determining whether I will become or remain a resident at Tenacre.

I have received and read a Notice and Disclosure explaining that such investigation reports may include information concerning my creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and/or mode of living. This information may be obtained from personal interviews with professional and personal acquaintances.

I understand that Tenacre and its agents are not responsible for the accuracy or completeness of the information contained in any such reports. I release Tenacre and its agents from all liability, claims, and lawsuits with respect to the information obtained from any and all the sources used by Tenacre.

I understand that this authorization is not an offer to the Christian Scientists-in-Residence program and that any false or misleading information I have provided to Tenacre may result in denial or withdrawal of my admission to the program.

I also understand that this authorization is a continuing authorization and will remain valid until such time as I inform Tenacre, in writing that I wish to revoke this authorization.

Tenacre may obtain investigation reports about an applicant in connection with an application for employment. Tenacre may also obtain such reports at anytime during an employee’s employment with Tenacre. Information gathered through such investigations is used for employment purposes including, but not limited to, hiring, reassignment, promotion, retention, and rehiring.

An investigation report may include information concerning creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and/or mode of living. Examples of investigation reports include, but are not limited to, criminal background reports, motor vehicle driving records, credit histories, reference checks, verification of education or past employment, and investigations into theft, fraud, harassment and work place violence. This information may be obtained from personal interviews with professional and personal acquaintances. With the exception of investigations into suspected misconduct of Tenacre employees, an applicant or employee has the right to request in writing, within a reasonable period of time, a complete disclosure of the nature and scope of an investigation involving personal interviews.

Because errors can occur, an applicant deemed ineligible for employment as a consequence of an investigation report will receive notice of this fact. It will be the applicant’s responsibility to contact the source of the information and to correct any errors. Tenacre accepts no responsibility for the accuracy of information contained in investigation reports. Tenacre is under no obligation to test the accuracy of such information, or to postpone an employment decision to permit an applicant an opportunity to challenge information, or to seek to correct it.

This Notice and Disclosure is made pursuant to the federal Fair Credit Reporting Act (FCRA) and the New Jersey Fair Credit Reporting Act (NJFCRA). These Acts are designed to promote the accuracy, fairness, and privacy of information maintained in the files of a Consumer Reporting Agency (CRA). Most CRAs are credit bureaus that gather and sell information about consumers – such as whether a consumer pays bills on time or has filed bankruptcy – to creditors, employers, landlords, and other business. Because employee background checks sometimes use information from CRAs, the Acts governing CRAs are sometimes applicable to employers. Additional information about these Acts is provided below.

The complete text of the FCRA, 15 USC Section 1681-1681u, and a description of a consumer’s right under the FCRA are available at the Federal Trade Commission’s Web site http://www.ftc.gov. The FCRA gives you specific rights, as outlined below:

• You must be told if information in your file has been used against you. Anyone who uses information from CRA to take action against you - such as denying an application for credit, insurance, or employment - must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.

• You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.

• You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs - to which it has provided the data - of any error). The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.

• Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.

• You can dispute inaccurate items with the source of the information. If you tell anyone - such as a creditor who reports to a CRA - that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.

• Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.

• Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA - usually to consider an application with a creditor, insurer, employer, landlord, or other business.

• Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your
  permission.

• You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
• You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.

The FCRA gives several different federal agencies authority to enforce the FCRA including:

Federal Trade Commission
Consumer Response Center - FCRA
Washington, DC 20580
202-326-3761

The NJFCRA provides similar rights summarized below. This summary is being provided to you pursuant to state law (N.J.S.A. §56:11-28 et seq.).

• Before an employer can obtain a consumer report about you from a consumer reporting agency they must provide you with a clear and conspicuous disclosure in writing that such may be obtained for employment purposes. You must provide written consent to the procurement, for employment purposes, of a consumer report.

• When using a consumer report for employment purposes, before taking adverse action based in whole or in part on the report, an employer must provide you with a copy of the consumer report and a description in writing of your rights under the federal Fair Credit Reporting Act as well as the NJFCRA.

• You must be afforded a reasonable opportunity to dispute, with the consumer reporting agency, any information on which the employer relied upon in your consumer report.

• You can request from a consumer reporting agency all information in your file, upon proper identification. This includes sources of information and identification of each person who procured a consumer report for employment purposes during the two-year period preceding your request. These requests must be made during normal business hours and on reasonable notice. It can be done in person or by telephone, if you have made a written request and pay the toll charge. A consumer reporting agency must provide trained personnel to explain to you any information in the consumer report.

• You can dispute inaccurate information with the consumer reporting agency. If you dispute the completeness or accuracy of any of the information in your file, the consumer reporting agency must reinvestigate free of charge during a 30 day period. A consumer reporting agency must provide written notice to you of the results of the reinvestigation not later than five business days after completion of the reinvestigation.

• If, after a reinvestigation, any information disputed by you is found to be inaccurate or incomplete or cannot be verified, the consumer reporting agency must promptly delete that item of information from your file or modify that item of information, as appropriate, based on the results of the reinvestigation.

• You can seek damages for noncompliance under the NJFCRA.