I certify that the information contained in this application is correct and understand that falsification of this information is grounds for dismissal. I authorize Mid Jefferson Hospital or its agents to conduct an investigation of my background for the purpose of confirming the information contained on my application, and / or obtaining other information which may be material to my qualifications for employment. I authorize any individuals or entities contacted during this investigation to give you any and all pertinent information they may have, personal or otherwise, and release all parties from any and all liabilities, claims, or law suits in regard to the information obtained. If an employment relationship is established, I agree to conform to the polices and procedures of Mid Jefferson Hospital and to support the facility’s commitment to operate in compliance with all applicable laws. I understand that all employees are subject to the rules and testing component of the facility drug d alcohol policy and that employment is contingent upon compliance with this policy.
I understand that my employment and compensation can be terminated with or without cause, and with or without notice, at anytime at the option of either the company or myself. I also understand that any period of employment is not for a specific duration and understand that with the exception of the Chief Executive Officer of the facility, no company representative has the authority to mane any oral or written agreements which are contrary to the forgoing.
I certify that I have read, understand, and agree with the above Disclaimer statement.*
I understand and agree to have my record investigated as to felonies, misdemeanors, or any other arrest. Further, I waive such legal rights if any that I may have and do release any and all persons from liability in connection with furnishing such information about me to the below listed company or business.