Personal Information

Employment Information

Employment History

Education History

College or University

Other Schools

Special Skills

Employment Record

Please list your most recent jobs first. Include military service as part of your employment record. If you have a resume, please attach it as well.

PLEASE READ CAREFULLY, INITIAL AFTER EACH PARAGRAPH, AND SIGN BELOW

I certify that I have answered the above questions truthfully and have not withheld any information relative to my application. I understand that any falsification, misrepresentation, or omission, as well as any misleading statements or omissions of the application information, attachments, and supporting documents generally will result in denial of employment or immediate termination, if discovered after hire.

I authorize Union County General Hospital to thoroughly investigate my references, work record, education and other matters related to my suitability for employment, and further authorize the references I have listed to disclose to the company any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I release Union County General Hospital, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I authorize Union County General Hospital to investigate whether I have a criminal record of convictions, and, if so, the nature of such convictions and all the surrounding circumstances of the conviction.

If hired, I recognize the rules and policies of Union County General Hospital. I understand that my employment and compensation can be terminated at any time, with or without cause, and with or without notice, at the option of Union County General Hospital or myself. I understand that the Administrator of the company is the only person who will ever have the authority to create any other terms of employment and/ or to enter into any employment contract and that all such contracts must be in writing and signed by both parties. However, I also understand that unless otherwise stated in an employment contract, the company may change, withdraw and interpret other policies (including wages, hours and working conditions) as it deems appropriate.

I understand and acknowledge that I may be required to submit to a physical examination, including drug test. Additionally, I hereby authorize the release of the results of such an examination to Union County General Hospital for their use in evaluating my suitability for employment. Further, I release the examining facility and Union County General Hospital from any and all liability, and from any damage that may result from the release of such information.

GENERAL INFORMATION

ADDITIONAL INFORMATION

SUPPLEMENT TO EMPLOYMENT APPLICATION

IMPORTANT INFORMATION TO KNOW BEFORE FILLING OUT AN APPLICATION FOR EMPLOYMENT WITH UNION COUNTY GENERAL HOSPITAL

1. All areas of the application must be filled out completely and accurately. Please fill in the required information directly on the application and do not indicate “see resume”.
2. If you are offered a position with Union County General Hospital be aware that we may verify all of the information that you have written on the application, as well as your resume. If there is a discrepancy in your information, the job offer may be withdrawn. It is important to be sure that what you have written is correct.
3. If you have any questions about completing the application, it is important to please ask the Union County General Hospital representative who has been assisting you.

Thank you for your cooperation.

APPLICANT ACKNOWLEDGMENT

My signature below indicates that I have read and understand the importance of supplying accurate information on the application. I am also aware of the possibility of an offer of employment being withdrawn if any of the information is not correct.