By submitting this form, I certify that the answers and information set out in this application for employment are true, accurate,
and complete to the best of my knowledge. I acknowledge that if any answer or information is not true, accurate, or complete, I
may not be hired, or if hired, I may be discharged. I authorize Myrtue Medical Center to investigate all statements contained in this
application for employment and to investigate my character and qualifications. I authorize my prior employers, references, and others
with information regarding my work or educational history, or my character, to provide Myrtue Medical Center with all requested
information and references, and to cooperate fully with the investigation of my character and qualifications. I further release Myrtue
Medical Center, and any person or organization providing information to Myrtue Medical Center regarding my work or educational
history, character, or qualifications from any liability for soliciting and securing or for providing such information.
I understand that this application is not a contract of employment, and I acknowledge that no oral representations have been made as
such. I further understand that I will only be considered for employment opportunities at Myrtue Medical Center for 90 days from the
date of this application. If hired, I understand that my employment relationship with Myrtue Medical Center is terminable at-will, with
or without cause, by either myself or Myrtue Medical Center.
In compliance with the Americans with Disabilities Act, I understand that if hired, I will be required to complete an employee health
screening medical history statement. This statement is required of all employees of Myrtue Medical Center. Any medical information
acquired will be preserved as confidential and kept in a file separate from my personnel file. If hired, I understand that the job offer
I receive will be “conditioned” upon my being able to perform the essential job functions of the position with or without reasonable