Please be as complete as possible, filling in all requested areas. If the answer is None, Unknown or Not Applicable (NA) please fill in the blank with that information. Incomplete applications will not be considered.
Typing (WPM), List Software Proficiencies, Business machines and or equipment you can operate.
(Intentional tort commonly refers to fraud, misrepresentation, slander, libel and false imprisonment are all usually considered intentional torts. So, too are assault and battery and false imprisonment.)
(Answering yes does not constitute an automatic bar to employment. Factors such as date of the offense, age at the time of offense, seriousness and nature of violation and rehabilitation as well as position for which application is being made will all be taken into account)
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I certify the information contained in this application is true and complete. I understand providing any false or misleading information, misrepresentation or willful omission of facts during the application or interview process may result in withdrawal from consideration for employment or my immediate discharge if already hired, regardless of when discovered. I authorize Mobridge Regional Hospital to investigate all statements in this application and to conduct a thorough investigation of my past employment, education, and job related activities. I indemnify Mobridge Regional Hospital against any liability, which may result from conducting such investigation. All employers, educational institutions, and references listed are hereby authorized to give Mobridge Regional Hospital any and all information regarding my employment and character are hereby released from any and all liability which may result from furnishing such information.
I understand this application is not a contract of employment and if hired, regardless of any oral representations to the contrary, the employment relationship between myself and Mobridge Regional Hospital is terminable-at-will such that both the hospital and I remain free to choose to end our work relationship at any time for any or no reason. I understand my employment is contingent upon a background check and passing the health assessment (pre-employment screening), including a drug screen, relevant to the position applied for in this application or the position for which I may be selected and I agree to undergo that assessment. I understand the Health assessment will be conducted by a provider at the Mobridge Medical Clinic or satellite clinic of Mobridge Medical Clinic to determine whether I can perform the essential functions of the job. I further understand a drug or alcohol test may be required depending hospital policy.
I understand that an investigative report will be made by a consumer reporting agency and its agencies to retrieve necessary information and prepare a Consumer Report. I understand that a Consumer Report may be prepared summarizing information from personnel files, educational institutions, to include a thorough investigation of my past employment, education, government agencies, companies, corporations, credit reporting agencies, law enforcement agencies at the federal, state or county level and job related activities related to my current and past activities which include criminal, civil and driving record. I authorize these entities to supply any and all information concerning my background. The information received may include but is not limited to, academic, residential, achievement, job performance, attendance, litigation, personal history, credit reports, driving records and criminal history records. I authorize this information to be transmitted electronically.
I authorize these entities to supply any and all information concerning my background including all employers, licensing boards, educational institutions, and references listed are here by authorized to give Mobridge Regional Hospital any and all information regarding my employment, licensure and/or education as well as character, general reputation, personal characteristics, and mode of living. All employers, educational institutions, and references listed are hereby released from any and all liability which may result from furnishing such information.
I understand that substance-abuse testing/drug testing may be a requirement of the position for which I am applying. I consent to this testing and understand I must bass the substance abuse test/drug test as a condition of employment or continued employment. I hereby authorize any physician, laboratory, hospital or medical professional designated by the above named company to conduct such testing and release the results to authorized representatives of Mobridge Regional Hospital.
I understand that only drug test results will be provided to and reviewed by a designated Medical Review Officer (MRO) of the Consumer Reporting Agency specified by Mobridge Regional Hospital and that the MRO may discuss the results of the drug test with me and ask about medical information specifically related to these drug test results. I understand that when this review is completed, only the drug test will be provided by the MRO to Mobridge Regional Hospital and no other medical information about me will be disclosed to anyone without first asking for and obtaining my specific consent to do so.
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