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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.

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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:

Date: 02/13/2016

Electronic Signature: (please enter your full name)

KSB Standards of Behavior

Providing a great experience for every patient, every time is our top priority here at KSB. We also want KSB to be the best place to work. You see that in our core values of integrity, respect, teamwork, and accountability.

These standards were developed by a team of your co-workers. They built a foundation of excellence for both patients and employees.

These Standards of Behavior are much more than words on a page. They come to life every day through excellent employees who lead by example. Your patients and co-workers will notice your commitment to excellence when you practice these standards in every interaction, on every shift, with everybody

Together, we can build the best team and provide the best patient care. These standards are steps on the journey toward that goay, and I'm excited to be walking with you.

David Schreiner, FACHE
Chief Executive Officer


In order to provide this consistency in our service, a set of behavior standards has been developed by a group of employees at KSB Hospital. All employees and volunteers are expected to practice these behaviors at all times. No matter what our job responsibility, each of us represents the Hospital in the eyes and ears of the community.

Professionalism: Attitude is the little thing that makes a big difference.
  • I will go beyond our patients' and visitors' expectations.
  • I will smile and make eye contact.
  • I will greet patients, visitors and other employees.
  • I will show a sense of ownership in all I do.
  • I will show concern by asking if I can help.
Safety: Safety is an ongoing process that starts with me.
  • I will use appropriate/proper tools in order to provide a safe work environment for the patients, employees, volunteers, and the hospital.
  • I will respect all equipment and make sure that it is in good working order.
  • I will use all equipment properly.
  • I will wear my ID badge at all times ensuring it is visible to the public.
  • I will maintain a clean work area.
  • I will be responsible for maintaining the cleanliness of the KSB facilities.
  • I will be aware of my surroundings and report any suspicious behavior.
  • I will be participate in our just culture environment.
  • I will report any safety concerns caused by myself and others and work with appropriate staff to better our process and create a safe environment for our patients and employees.
Communication: Open communication benefits our customers, patients, employees & volunteers.
  • I will use the best method of communication for the issue at hand, i.e. email, telephone or face-to-face meeting.
  • I will be mindful of the fact that KSB’s telephone and electronic resources are to be used for business purposes.
  • I will make sure I answer the telephone with a friendly smile, welcoming tone of voice, identifying myself by name, and by department for both internal and external phone calls.
  • I will not transfer calls more than twice and if I need to transfer the phone call, I will stay on the line and announce the caller by name.
  • I will make sure to include all pertinent information when communicating with others.
  • I will not speak unkindly in regards to another department.
Excellent Service: The highest quality of service begins with excellent care.
  • I will treat everyone as if they were my only customers for today.
  • I will provide competent care.
  • I will be efficient in my tasks/resources.
  • I will measure what is important so that I focus my efforts to improve results.
  • I will communicate in such a manner that customers understand and ask if they have any questions.
  • I will provide prompt care and thank them for waiting.
  • I will apologize for any delays.
  • I will value the diversity of our patients, employees, business colleagues and visitors and treat them with the kindness and respect regardless of their background, race, religion or culture.
Privacy/Confidentiality: By maintaining privacy, we earn the trust of our community.
  • I will respect patient privacy.
  • I will communicate with patients’ families in a private manner.
  • I will not discuss patient/visitor issues in public areas.
  • I will follow the hospital policy for release of information.
  • I will correctly sign in and out of the computer.
  • I will access only the patient information for which I have a need in order to complete my job duties.
  • I will be informed and knowledgeable about the current HIPAA regulations.
Teamwork: Teamwork is the ability to work together toward a common goal.
  • I will welcome new employees and volunteers and set an example of the cooperation expected in the workplace by offering to help them get acclimated to their new job.
  • I will always be willing to help co-workers.
  • I will provide support to my fellow team members so they can participate, learn and grow.
  • I will respect my co-workers by not gossiping.
  • I will have an appropriate sense of humor to make the work place fun.

I have read and understand the Standards of Behavior:

I agree to comply with the above behaviors:

Date: 02/13/2016

Electronic Signature: (please enter your full name)

AFFIRMATIVE ACTION INFORMATION

THE BELOW QUESTIONS ARE OPTIONAL

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.

Gender:
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Female

Ethnicity:
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American Indian/Alaskan Native
Asian/Pacific Islander
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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
Disabled Veteran
Individuals with Disabilities

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The Pulse of KSB

For insight, analysis, and updates on KSB and the healthcare industry, visit www.ksbpulse.com, a blog written by David Schreiner, President/CEO of KSB Hospital, and other guest authors. You can sign up for a weekly email newsletter to ensure you never miss a beat of The Pulse of KSB!

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