I certify that the above information is correct and complete to the best of my knowledge. I understand that omissions or false statements on this application are cause for denial of employment or subsequent dismissal.
I authorize the Hospital to contact my former employers for references and to conduct an agency check for criminal convictions. I understand that, if employed, I will be an "at will employee" and may terminate my employment or be terminated by the Hospital at any time, for any reason. I agree, if employed, to abide by Hospital policies.
I understand that as a condition of employment, I agree to receive an annual influenza vaccine by one of the accepted means. I also understand that the only acceptable reasons for declining the vaccine are because of medical or religious grounds and that I will need to provide appropriate documentation supporting such grounds.