Personal information:
Education:
Employment History:
Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent. Please attach a resume if applicable. Incomplete information could disqualify you from further consideration.
References:
Give the names of three persons not related to you, whom you have known at least three (3) years
Release and Understanding:
Please Review and Acknowledge That You Understand The Following.
In making application for employment:
* I certify that the information in this application is true and complete for all
practical purposes. It may be verified by the facility or any affiliate.
Should a position be offered and later it is found that the information is significantly
untrue, incomplete, or misrepresented, I understand and agree that the facility
or its affiliates are relieved of all commitments, financial or otherwise pertinent
to employment, and that I am subject to immediate discharge without recourse.
* I understand that an investigative report may be made by a consumer reporting
agency to include information as to my character, general reputation, personal characteristics,
and mode of living, whichever may be applicable. If such an investigative
report is made, I understand that I will receive notice that such a report has been
requested, and that I will have the right to make a written request for a complete
and accurate disclosure of additional information concerning the nature and scope
of the investigation.
I UNDERSTAND AND AGREE THAT ANY EMPLOYEE HANDBOOK WHICH
I MAY RECEIVE WILL NOT CONSTITUTE AN EMPLOYMENT CONTRACT, BUT WILL BE
MERELY A GRATUITOUS STATEMENT OF FACILITY POLICIES.
* I understand
that the facility reserves the right to require its employees to submit to blood
tests or urinalyses for alcohol or drug screens, or to allow inspection of bags
(including purses or briefcases) or parcels brought into or taken out of the
facility. I understand that refusal to submit to a urinalysis or blood
test, when requested to do so, may result in termination of my employment.
* Compliance with this facility's Substance Abuse Policy is a condition of
employment. This hospital requires that every newly hired employee be
free of alcohol or drug abuse. Each offer of employment is contingent
upon successfully completing a urinalysis test/screen for alcohol and
drugs in accordance with hospital policy. Continued employment is also contingent
upon compliance with the hospital's Alcohol and Drug Abuse Policy.
I UNDERSTAND AND AGREE THAT IF I AM OFFERED EMPLOYMENT
BY THE FACILITY, MY EMPLOYMENT WILL BE FOR NO DEFINITE TERM AND THAT EITHER I,
OR THE FACILITY WILL HAVE THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP
AT ANY TIME, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE,
I ALSO UNDERSTAND THAT THIS STATUS CAN ONLY BE ALTERED BY A WRITTEN CONTRACT
OF EMPLOYMENT WHICH IS SPECIFIC AS TO ALL MATERIAL TERMS AND IS SIGNED BY
ME AND THE ADMINISTRATOR OF THE FACILITY.
Release:
I
hereby authorize any prior employers to provide such information concerning
my employment with them as may be requested, and also authorize the Registrar/Placement
Office of all educational institutions attended to release an official copy
of my transcript and, if available, faculty appraisals. I also authorize
any appropriate licensing board to release full information concerning
my licensure status and my licensure history.
I agree that I will settle any and all claims, disputes or controversies arising
out of or relating to my application for employment, employment or termination of
employment with the employer exclusively by final and binding arbitration and
before a neutral Arbitrator and in accordance with the rules and procedures for
employment disputes adopted by the employer. Such claims shall include those
that could be brought in a court of law under any applicable federal, state or local
statutory or common law, such as the Age Discrimination in Employment Act, Title
VII of the Civil Rights Act of 1964, as amended, including the amendments of the
Civil Rights Act of 1991, the Americans with Disabilities Act, the Family and Medical
Leave Act, state civil rights acts, the law of contract and the law of tort.