I hereby certify that the information contained in this application form is true and correct and agree to have any of the statements made by me in this application checked for accuracy by MemorialCare, unless I have indicated to the contrary on this application. I authorize the references and employers listed above, as well as all other individuals whom MemorialCare contacts, to provide to MemorialCare any and all information concerning my previous employment and any other pertinent information that they may have. In addition, I authorize MemorialCare, any related entity, and their respective employees and agents, to request and receive any information and records concerning me, to the extent permitted by law, including, but not limited to, records regarding professional and vocational licenses or certifications, military service, and civil and educational history, from any individuals, corporations, partnerships, associates, institutions, schools, governmental agencies and departments, licensing agencies, public agencies, private organizations or other entities.  I release all such parties and persons from any and all liability from any damages that may result from furnishing such information to MemorialCare. Further, I release MemorialCare and its employees, agents and representatives from any and all liability resulting from collecting such information, as well as the use or disclosure of such information.  I also agree to authorize an appropriate background check for MemorialCare to review my criminal history, including driving records, and authorize any courts or law enforcement agencies contacted to release relevant records and information pursuant to that separate authorization. 

I understand that all offers of employment are conditioned on my successful completion of a criminal background investigation, a medical examination, TB skin test, annual flu vaccination, a test designed to detect the presence of illegal drugs (I will disclose any legal drugs [e.g., prescription medication] before test is administered), all reference checks, and on the provision of satisfactory proof of my identify and legal authorization to work in the United States.

I understand that any misrepresentation, falsification, or material omission of information in this application or throughout the hiring process may result in my failure to receive an offer or, if discovered after I’m hired, shall serve as adequate grounds (i.e., good cause, and a legitimate, non-discriminatory, and non-retaliatory reason) for termination of my employment. If I am hired, I agree that in consideration of my employment, I will abide by MemorialCare’s policies and procedures, including the Code of Conduct, as they may be amended, and agree that subject to an applicable collective bargaining agreement, my employment can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of MemorialCare.

I understand that no employee or representative of MemorialCare, other than the President or the Chief Human Resources Officer of MemorialCare, has the authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

MemorialCare believes that all individuals are entitled to equal employment opportunity. This means that MemorialCare does not discriminate against employees or applicants because of race, color, religion, sex, pregnancy, national origin, gender, ancestry, age, marital status, sexual orientation, physical or mental disabilities, medical condition, genetic characteristic, citizenship, or any other protected characteristic. Employment decisions will be based on each individual’s qualifications that relate to the position being sought, together with any other lawful considerations, such as those that may be set forth in any relevant collective bargaining agreement.