Have you ever been convicted of a felony? (Conviction of a criminal offense will not necessarily preclude your employment.)

I hereby certify that the information and facts set forth in this application are true, complete and accurate to the best of my knowledge. I understand that any falsifications, misrepresentations or omissions of any facts in this application or other documents submitted for consideration of employment will be cause for denial of employment or immediate termination of employment, if employed regardless of the timing or circumstances of discovery.

I understand that if I am hired this Application becomes a part of my official employment record.

I authorize Memorial Hospital to verify the accuracy of any information provided or known. I hereby authorize any and all schools, employers, references, regulatory boards, courts and any others who have information about me to provide such information to Memorial Hospital and/or any of its employees, representatives, agents or vendors. I release all parties involved in this process from any liability for any and all damage that may result from providing such information.

I understand that if offered a position, I may be required to submit to a pre-employment drug screening and criminal background check as a condition of employment. I further understand that I will be required to complete a pre-employment physical exam. I understand that receipt of unsatisfactory results from, failure to complete as required or any attempt to affect the results of these, will result in the immediate withdrawal of any offer of employment or the termination of employment, if already employed.

I understand that submission of an application does not guarantee employment. I further understand that should an offer of employment be made by Memorial Hospital, such offer, whether or not stated, is for employment at will, and that if I accept such offer, my employment may be terminated by either the Company or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, or statements of Memorial Hospital or its employees or representatives used during the hiring process or during my employment may be deemed to be a contract for employment, either actual or implied. I understand that no employee or representative, other than the CEO of Memorial Hospital, has the authority to enter into any agreement contrary to the above and that any such agreement if made shall not be binding unless it is set out in a writing signed by the CEO of Memorial Hospital.

In consideration of employment, if offered, I agree to abide by and adhere fully to all rules, regulations, policies and procedures of Memorial Hospital at all times. I further understand that the Company's rules, regulations, policies and procedures may be changed at any time, with or without notice.