Type / Organization or State Issued / Date Issued / Document # / Verified?
Acknowledgement and Certification
All applicants will be given equal opportunity without unlawful regard for race, color, religion, national origin,
sex, age, marital, dependent or veteran status, physical or mental disability, height, weight, or any other legally protected status. No question on this application is intended to secure information to be used for such discrimination.
I understand that if I have a disability, and need accommodation in any step of the hiring process, or to
assist me in any demonstration (required of all applicants for the job) of qualifications to perform the duties of the job for which I am applying, I should inform the Personnel Office. Failure to notify Marquette County Medical Care Facility may preclude any claim that the Facility failed to reasonably accommodate my disability.
Any misrepresentation in this application or other information submitted by me, any refusal by me to sign
lawfully required releases, consents, or waivers, and any failure by me to properly complete any lawfully required forms (I-9, W-4, etc.) may result in cancellation of this application for employment and/or separation from Marquette County Medical Care Facility's employ, if I have been employed.
I acknowledge that consideration for employment is contingent upon the results of a reference and background check and, if I am offered employment, that my employment is conditional until the results of any required criminal records checks and/or post-offer physicals are known. I hereby consent to required fingerprinting and criminal records checks and, should I be offered employment, to required post-offer physicals, including drug screening. I authorize you to investigate the truthfulness of all statements in this application or in connection with any post-offer physicals, to contact former employers and other listed references or any other persons who can verify information, and to discuss the results of any investigation with the employees of Marquette County Medical Care Facility involved in the hiring process. I give my consent for all contacted persons to provide any information concerning this application, including any postoffer physicals, and authorize release of information concerning disciplinary action without any obligation to give me written notice of such disclosure. I agree to execute any lawful releases, consents and waivers required by you. I hereby release you and any other person from any liability whatsoever as a result of such
inquiries and disclosures.
I authorize Marquette County Medical Care Facility to contact the references listed on this application to discuss questions regarding my employment/character. I hereby release the references/Marquette County Medical Care Facility from liability or damages for providing such information.
I certify that I have read and understand the above stated policies and that I will, if I accept employment with
Marquette County Medical Care Facility, comply with these and all other Facility policies, rules and regulations. Unless otherwise provided in writing, my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either Marquette County Medical Care Facility or myself. I understand that no representative of Marquette County Medical Care Facility, except by specific written authority of the Administrator, has authority to enter into any agreement of any specified time or make any agreement contrary to the foregoing.
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.
This application will be kept on active file for six (6) months.