Step 1 - General Information
Step 2 - Previous Work Experience
Step 4 - Position Specifics
Step 5 - Educational History
Step 6 - Professional Affiliations
- Include Driver's License, if applicable
- Include Type, State Issued, Expiration Date and Number.
- Indicate if any licenses have been revoked, suspended or placed on probation.
- Also indicate if you are ineligible to become licensed or certified in your field. Please explain.
Step 7 - Other Skills
Step 8 - Resume
Step 9 - References
Step 10 - Notify in Case of Emergency
Step 11 - Applicant's Certification and Agreement
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice.* I understand that if I am hired, I will have the right to terminate my employment at any time, with or without notice and with or without cause. I understand and agree that the hospital will have the same right.
*NOTE: The provisions of the Fair Credit Reporting Act may by applicable if a credit report is obtained and considered.
Step 12 - Background Investigation Authorization Form
I authorize Newberry County Memorial Hospital and any of its affiliates or its designated investigative ('agency') to make whatever inquiries it may deem necessary in connection with my application for employment. As part of such inquiries, the Hospital, the affiliate, and the agency have my permission to contact persons who may have information relating to my suitability for employment and to secure consumer credit reports (including investigative consumer reports). I understand that information obtained by the Hospital, the affiliate, or the agency in accordance with this authorization may include information pertaining to my character, general reputation, personal characteristics, work habits, mode of living, driving record, judgment, liens, arrests and convictions.
I authorize NCMH and its affiliates, without reservation, to furnish copes of this authorization and my application to any person(s) and/or consumer reporting agency(ies) in connection with the above purposes.
All fields are required. If the field does not apply to you please enter "N/A".
Step 13 - Notice On Consumer Reports
Please take notice that the Hospital may obtain or cause to be prepared either a Consumer Credit Report or an Investigative Consumer Report on you for employment purposes. That information will be kept confidential to the extent required under the Fair Credit Reporting Act.
As an Equal Opportunity Employer, the Hospital will not use any information in any of these reports in violation of any applicable federal or local equal employment laws or regulations.
In the event that any adverse employment actions is taken with respect to you based in whole or in part on the results of the Consumer Report or Investigative Consumer Report, you will be provided a separate notice of you rights under the Fair Credit Reporting Act.
I hereby consent to the Hospital obtaining a Consumer Report or Investigative Consumer Report on me for employment purposes, and authorize the Hospital to obtain such a report(s).
Final Step - Submit