Occupational Medicine – Patient Care Representative

I authorize any employer, school, or person named by me to release any information regarding me or my employment. I hereby release said individuals or organizations from liability for any damage for issuing such information. I certify that the answers given by me to the foregoing questions and statements are true and correct. Further,. any falsification, omission, or misrepresentation of information supplied by me, either orally or on any company document, will be sufficient cause for elimination from continued employment. I understand that neither this document nor any offer of employment from the employer constitutes an employment contract. Furthermore, I understand that any employment is “at will”, which means that either I or Elmore Community Hospital or Lake Martin Community Hospital may terminate my employment at any time with or without cause, reason, or notice. No manager or representative of Elmore Community Hospital or Lake Martin Community Hospital has any authority to enter into an agreement of employment for any specified length of time. In making this application for employment, I agree to submit to a post-offer pre-employment drug and health screen. Should the results of this be unsatisfactory in the judgement of Elmore Community Hospital or Lake Martin Community Hospital, the job offer will be withdrawn. If offered employment, Elmore Community Hospital and/or Lake Martin Community Hospital will be required to verify my identity and eligibility to work in the United States of America, in accordance with the Immigration Reform and Control Act. I understand that documents to verify my identity and eligibility for employment may be submitted in accor dance with regulations of the US Immigration and Naturalization Service. Submitting this information is an acknowledgement that I have read and understand this document. Elmore Community Hospital and/or Lake Martin Community Hospital is an equal opportunity employer. Elmore Community Hospital and/or Lake Martin Community Hospital considers applicants for all positions without regard to race, color, religion, sex, national origin, marital or veteran status, the presence of disability, or any other legally protected status.