Job Application

Job Application

Applicant Information

First
Last
M.I.
Address
City
State/Province
Zip/Postal

Education



Professional Licensure, Registry, Certification

Please list type of license, registry or certification

Special Skills

Previous Employment

Address
City
State/Province
Zip/Postal
Country

Address
City
State/Province
Zip/Postal
Country

PLEASE READ CAREFULLY BEFORE SUBMITTING

I certify that the information contained in this application is correct to the best of my knowledge and understand that any falsification or misrepresentation or omission on this application is grounds for refusal to hire, or if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give Healthplex Associates Inc. any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application and release all such parties and Healthplex Associates Inc. from all liability for any damage that may result from furnishing such information. I authorize Healthplex Associates Inc. to request and receive such information.

  • If employed, I understand that I will be an employee “at will” and either Healthplex Associates Inc. or I may terminate my  employment relationship at any time with or without notice of any reason.
  • I agree to comply with the rules, regulations and policies of Healthplex Associates Inc., and acknowledge that these rules, regulations and policies may be changed, interpreted, withdrawn or supplemented any time, and without prior notice to me. I further acknowledge that none of these rules, regulations or policies constitutes a contract of employment between me and Healthplex Associates Inc.
  • I acknowledge that any offer of employment, or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, any time, at the option of Healthplex Associates Inc. or myself. I understand that his application and any other documents which I receive are not contracts of employment. I further understand that no representative of Healthplex Associates Inc. other than an officer has any authority to enter into any agreement for employment for any specified period of time or to assure any other personnel action, either prior to commencement of employment or after I
    have become employed, or to assign any benefits or terms and conditions of employment, or make any agreement contrary to the foregoing.
  • I understand that a drug screening (including nicotine screening) and criminal background check may be a requirement and understand that any offer of employment may be withdrawn contingent upon my passing this drug and nicotine screening and background check.
  • I agree to submit to any influenza vaccinations as required by the affiliating hospital system and understand that failure to comply with hospital required vaccinations could result in immediate termination of my employment.