(PLEASE READ CAREFULLY)
I UNDERSTAND AND AGREE THAT:
All statements that I have made in connection with my application for employment are true, and that I have not
withheld any personal information. I understand that any misrepresentation or purposeful omission of facts made in
connection with my application for employment or in my interview, are reasons to disqualify me from further consideration
and can be grounds for termination if I am hired.
I authorize any person or persons to give Alice Hyde Medical Center representatives any information about me in
connection with my application for employment, and release them from any liability for doing so.
I understand that acceptance of a job at Alice Hyde Medical Center may require overtime and weekend work.
I also understand that my application will be valid for 12 months and will not be considered after 12 months has
Please make a selection.
CHECK HERE TO INDICATE THAT YOU HAVE READ AND AGREE TO THE ABOVE