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Statement of Care
It is the position of Bellin to provide care to all patients with no regard for reason of treatment. To this end, and as a condition of employment, all employees will need to accept job assignments to meet staffing needs.
Truth of Statements and Authorization for References
I hereby certify that the answers given by me to the above questions and statements are true and correct and hereby authorize you to contact references, past or present employers, persons, schools, law enforcement agencies, and any other source of information that may be relevant to my application for employment. It is understood and agreed that any misrepresentation, false statement or omissions by me in this application will be sufficient reason for rejection of my application or for dismissal at any time during my employment, without liability to this system.
I further understand that no representative or employee of Bellin has the authority to enter into any agreement or contract regarding direction or terms and conditions of employment other than an officer or official of the company, and then only by means of a signed, written document. I understand Bellin is not guaranteeing employment for anyone and that my employment may be terminated with or without cause, and without notice, at any time, at my option or Bellin's, unless specifically provided in a written employment contract. No additional employment contract is created by virtue of my being hired by Bellin. I further understand job responsibilities are subject to change in order to meet organizational needs.
Release of Liability Statement
I release from any and all liability all representatives of Bellin Health and any Bellin Health facility for their acts performed in good faith and without malice in connection with evaluating my application, credentials and qualifications. I further authorize any party having information bearing upon my qualifications for employment to release such information to any Bellin Health facility (unless otherwise stated). I also release from any and all liability all individuals and organizations who provide information to any Bellin Health facility in good faith without malice concerning my employment competencies, ethics, character and other qualifications, including other privileged or confidential information, and if I am employed, I also authorize Bellin Health to release such similar information to prospective future employers, and I release Bellin Health and its employees from any liability or damages that may result from providing such information.
- I consent to any pre-employment physicals or drug testing that is required by Bellin Health. I further agree that Bellin Health may obtain a copy of my driving record if relevant to the position I have applied for.
- I further represent that I am not legally restricted in any manner from being employed by Bellin Health.
- I have a legal right to work in this country, and I understand that I will be required to provide verification of my right to work after the decision has been made to hire me. I also understand that my failure to provide verification in a timely manner will result in my termination.
- I acknowledge as an applicant I have the responsibility to communicate to Bellin Health all updates and changes to this application that occur between the completion of the application and any interview and/or telephone screen that may take place when being considered for an open position.
Agreement to Terms
I acknowledge that I have read and agreed to the terms of the application including the Statement of Care, Truth of Statements and Authorization for References, Employment At-Will and Release of Liability Statement.
My signed name below shall have the same force and effect as my written signature. Please sign using a mouse or touch device.