Important Notice: Complete each applicable section and provide accurate information to receive consideration for employment. Dates of previous employment must include month and year. Applicant’s signature is required.
I certify that all information I provide in order to apply for and secure work with Hospital District #6 is true, complete and correct.
I understand that any information provided by me that is found to be false or misleading or incomplete or misrepresented, in any respect, will be sufficient cause:
1) to remove my application from further consideration
2) for my discharge immediately upon discovery
I expressly authorize, without reservation, Hospital District #6 and its representatives and employees and agents, to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions, and to verify the accuracy of all information provided by me on this application or in a resume’ or during a job interview.
I hereby waive any and all rights and claims I may have regarding Hospital District #6 and its agents and employees and representatives, for seeking and gathering and using such information in the employment process. I hereby waive any and all rights and claims I may have regarding all individuals, corporations or organizations for furnishing such information about me to Hospital District #6.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from Hospital District #6 and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
If offered a position at Hospital District #6, I understand that while I may resign at any time, certain restrictions will be applied to me if I resign without providing a notice of resignation (two weeks-non-managerial staff, 30 days-management positions).
I understand that this application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of Hospital District #6 is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by Hospital District #6’s Chief Executive Officer. I understand that if employed that my employment will be at the will of of HD6 and may be terminated at any time, for any reason, with or without cause or notice. I also understand that as an employee I may terminate employment with HD6 at any time, for any reason, with or without cause or notice.
I understand that if I am offered employment, all positions require a post-offer, pre-placement physical which includes a physical assessment, TB test, drug/alcohol screen and back strength evaluation and I agree to submit to these tests. I also understand I may be required to submit to drug or alcohol testing done randomly throughout employment or when reasonable suspicion indicates drugs or alcohol may have contributed to a work related accident or suspicious behavioral incident.
I am aware and understand that I will be required to provide proof of my identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form.
I certify that I have read, fully understand and accept all terms contained in this Applicant Statement.
Important Notice: Hospital District #6 is an equal opportunity employer. Applications are considered for employment without regard to age, race, color, religion, sex, national origin, ancestry, medical condition, or disability.
