If your answer is "Yes" to any of the above, you will not be automatically disqualified from employment consideration, except as required by state or federal law.
Carefully read this section prior to providing signature below.
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false information 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 understand that employment may be conditioned upon successfully passing a medical examination and that I may be required to satisfactorily complete a drug screening as a condition of employment.
I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with and 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 or use of such information.
I understand that my employment is at-will which means that I may terminate the employment relationship at any time and for reasons with or without notice, and that the facility has the same right. I understand that no one has the authority to enter any agreement contrary to the proceeding sentence, except for written agreement signed by an administrative representative of this facility and notarized.
I have read and understood the above information, and assert that all information provided by me is true and accurate. (Entering your name below constitutes an electronic signature and shall have the same effect as a written signature.)
Do you Agree to above:
These Standards of Behavior have been developed by the employees of KSB Hospital to establish specific behaviors that all employees and volunteers are expected to practice.
By incorporating our core values and these standards as a measure of overall work performance, KSB Hospital makes it clear that employees and volunteers are expected to adhere to and practice the standards of behavior.
I have read and understand the Standards of Behavior:
I agree to comply with the above behaviors:
Voluntary Affirmative Action Information
(completion of information below is voluntary)
As required, we comply with government regulations including Affirmative Action obligations where they apply.
In an effort to comply with requirements regarding government record keeping, reporting and other obligations, we ask that you complete this data survey. Your cooperation is appreciated.
Please be advised that your survey is not part of your official application for employment. It is considered confidential information that will not be used in any hiring decision.
American Indian/Alaskan Native
SPECIAL NOTICE TO VIETNAM ERA VETERANS, DISABLED VETERANS AND INDIVIDUALS WITH PHYSICAL OR MENTAL HANDICAPS OR DISABILITIES:
Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans of the Vietnam Era and qualified handicapped individuals.
You are invited to volunteer this information, if you qualify, to assist in proper placement and determining reasonable accommodation. This information will be considered confidential, and refusal to provide this information will not adversely affect your consideration for employment.
If you wish to be identified, please check if any of the following are applicable:
Vietnam Era Veteran
Individuals with Disabilities