2) Your Information
4) ExperiencePlease complete the following section even if a resume is enclosed. List all employers starting with most recent. List all employers for the past 10 years or the last four employers, whichever covers the longest period. You may list more employers on a separate sheet of paper if you desire. If previously employed under another or maiden name, please indicate so.
5) References(Please exclude former employers and persons related to you)
APPLICANT AUTHORIZATION AND CONSENT FOR RELEASE AND DISCLOSURE OF INFORMATION
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements, misleading statements, or omissions on this application shall be considered sufficient cause for dismissal. You are hereby authorized to conduct an investigation of any information provided on this application.
I understand that Ste. Genevieve County Memorial Hospital (SGCMH) participates in E-Verify and will provide the Social Security Administration (along with the Department of Homeland Security, if necessary) information from my Form I-9 to confirm my work authorization. All new employees are required to undergo blood and/or urinalysis screening for drug use as part of their pre-employment health screening. If I am accepted for employment, I agree to take a drug and/or alcohol test(s) when requested by SGCMH. I understand that taking such tests is a condition of my employment.
Also, as a requirement of the employment application process, I consent to the release of my criminal records to my employer. My prospective employer will consider material contained in my criminal history records solely for the purposes of determining my suitability for the position(s) for which I applied. I do not authorize release of this information for any purposes beyond this employment decision. I understand this application does not create an employment relationship or a contract of employment with Ste. Genevieve County Memorial Hospital.
Should I become employed as a result of my application inquiry, my employment will be “at will” and SGCMH will have the right to terminate my employment without notice or cause.
This application is active for only 90 days. At the conclusion of this time, if I have not heard from SGCMH and still wish to be considered for employment, it will be necessary to fill out a new application.