I certify that all the information I have provided in order to apply for and secure work with this employer is true, complete, and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and nondefamatory information, in a lawful manner, in the employment process and all the other persons, corporations, or organizations for furnishing such information about me.
I understand this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
I understand that in order to be eligible for employment at Stanton Health Center, I must not be listed on HHS-OIG’s List of Excluded Individuals and Entities, the General Services Administration’s List of Parties Excluded from Federal Procurement and Non-procurement Programs, or the Nebraska Medicaid Excluded Provider’s Database.
I understand that this application is not a contract of employment. I also acknowledge that no oral representations have been made, and that no one has the authority to make oral contracts of employment. If hired, my employment relationship is terminable at-will, with or without cause, by either myself or the Employer. No implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that this employer uses E-Verify and will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s I-9 Form to confirm work authorization.
I also understand that if there are any adverse findings on the criminal background check, adult registry of abuse and neglect, child abuse registry of abuse and neglect, or the sex offender registry, the facility may choose to terminate employment.
I understand that if any adverse findings are found on the Nurse or Nurse Aide Registry, the facility CANNOT employ me.
Applicants are not obligated to disclose any sealed criminal record.
I understand that any information provided by me that is found to be false, incomplete, or misrepresented, at any time, in any respect, will be sufficient cause to:
- Eliminate me from further consideration for employment, or
- May result in my immediate discharge from the employer’s service.
