825 Centennial Dr • Chadron, NE 69337308-432-5586 • FX 308-423-2737
APPLICATION FOR EMPLOYMENT (Please Print Plainly)
Please indicate visa type or other immigration status. If applicable.
If Licensed, Registered or Certified
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The facts set forth in my application for employment are true and complete. In the event of employment, I understand that false or misleading information given in my application or interview is sufficient cause for dismissal. I further understand that this applicant is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decided to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one has any authority to enter into any agreement contrary to the foregoing.
I agree to submit to a pre-employment physical and recognize employment is contingent upon successfully meeting Hospital Physical Requirements. If employed my employment will be on probationary basis for a period of 90 days.
In making this application for employment, I authorize personnel representatives of this facility to contact any of my schools, former employers, or other references unless otherwise stated. This is to be done for the purpose of collecting information and an account of their expertise with me. This inquiry if made may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have a right to make a written request within a reasonable period of time to receive the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report. I understand, also, that I am required to abide by all rules and regulations of the employer.
I, the submitter, certify that the information given by me is correct by clicking the submit button.