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Application for Employment


Personal Information


Employment Desired


Employment History



  • PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION FORM. I hearby affirm that the information on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I consent to take the physical examination, and such future physical examinations as Buehler Memorial shall designate. I understand that if the results of the physical indicate that I cannot perform the job, the contingent job offer will be rescinded. I understand that a drug screening will be conducted by an independent laboratory, and a positive test result will result in the contingent job offer being rescinded. I understand that a background investigation may be conducted under the Healthcare Worker Background Check Act, and a disqualifying conviction will result in the contingent job offer being rescinded. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing of or use of such information. I understand that any subsequent employment is at-will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for a written agreement signed by the Administrator of this facility.


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