We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age,
disability, marital or veteran status, or any other legally protected status.
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Full-Time (please indicate 1 2 3 shift)
Part-Time (please indicate Mornings Afternoons Evenings)
Temporary (please indicate dates available)
WE ARE AN EQUAL OPPORTUNITY EMPOYER
Start with your present or last job. include any job-related military service assignments and volunteer activities. You
may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected
Production/Mobile Machinery (list)
I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving
at employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant
wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being
accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with
this organization is of an “at will” nature, which meane that the Employee may resign at any time and the Employer may
discharge Employee at any time with or with out cause. It is further understood that this “at will” employment
relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in
writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may
result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Check box for agree or disagree and date.
(To be used regarding applicants for pre-employment references)
I authorize Sumner Regional Medical Center to contact any company, institution, or individual it deems appropriate to
investigate my employment history, job performance, background, qualifications, driving record, and other relevant
information, if job related. I give my full consent for all contacted persons including former employers to provide
the information concerning this application. I waive my right to bring any cause of action against these individuals
for any and all liability for damages arising from furnishing the requested information to Sumner Regional Medical
Check box for agree or disagree.