Agreement and Applicant Release

I understand that the information on this application has been requested for the purpose of evaluating my qualifications for employment and that this document, or any item discussed regarding employment, does not constitute a contract or promise of employment. I affirm that the information provided in my application, résumé and interview is true and correct to the best of my knowledge.

I authorize Community Memorial Hospital to investigate my background including all the information contained in my application and information I provide in the interview.

I understand and agree that any offer of employment is dependent upon my satisfactory completion of Community Memorial Hospital’s pre-employment investigation, which may include but is not limited to a pre-placement health assessment; verification of current work authorization in the United States; criminal history check; Office of the Inspector General check; work history verification; reference checks and any other investigations required by the position for which I am applying or mandated by local, state or federal laws. I waive and release any and all claims, including but not limited to claims of defamation, libel and slander, that I may have against any such individual or company as a result of their compliance with Community Memorial Hospital’s request for information.

I authorize all educational institutions I have attended to provide Community Memorial Hospital with all information which it seeks related to the dates of my attendance, the degrees I have named, the courses I have taken, my grades and related matters. I waive and release any and all claims I may have against these institutions as a result of their compliance with Community Memorial Hospital’s request for information.

I understand that Community Memorial Hospital is a Tobacco, Drug, and Alcohol Free Campus.

By signing below, I am affirming my understanding and acknowledgment of support in all items addressed in this document. I further understand that if I am hired by Community Memorial Hospital and I am not covered by a collective bargaining agreement containing a contrary provision, my employment will be “at will”, which means that either Community Memorial Hospital or I may terminate the employment relationship at any time for any reason. I further understand that, if hired, my “at will” employment may only be changed in a written document signed by the CEO/Administrator of Community Memorial Hospital (or designee), and that no representative of Community Memorial Hospital has the authority to make any oral promise to me concerning my employment.

I hereby certify that all the statements and answers set forth on the application form and/or my résumé are true and complete to the best of my knowledge, and I understand that if any statements and/or answers are found false or that information has been omitted, such false statements or omissions may be cause for rejection of my application or termination of my employment.

Entering your full name above constitutes a legal signature and indicates your agreement with our Agreement and Applicant Release conditions shown above.