Check all that apply

List three professional references (supervisors, co-workers, and/or instructors, who are familiar with the quality of your work, and have known you at least two years).

List each employer, beginning with the most recent. Please complete all fields to the best of your knowledge.

List three professional references (supervisors, co-workers, and/or instructors, who are familiar with the quality of your work, and have known you at least two years).

PLEASE CHECK EACH REFERENCE FIELD TO MAKE YOU THE INFORMATION IS CORRECT. DO NOT AUTO-FILL THESE FIELDS.

I certify that the information I have provided on this application is true and complete to the best of my knowledge, and that I have not knowingly withheld any fact or circumstances which would, if disclosed, affect my application. I fully understand that the misrepresentation or omission of facts or circumstances will be sufficient cause for rejection of my application if Marlette Regional Hospital has not employed me and for immediate dismissal if Marlette Regional Hospital has employed me. I grant permission to Marlette Regional Hospital’s employment representatives to contact any of the employers, supervisors, managers, educational institutions, and/or references listed in this application unless I have indicated to the contrary in the appropriate fields on this application. I authorize my former and/or current employer(s) to release information pertaining to my work record, work habits, and my work performance while in their employ. I understand that Marlette Regional Hospital may and hereby authorize it to solicit information regarding my character, criminal background record, driving record, previous employment, and/or similar background information pertaining to the position for which I am applying and hereby release all individuals and organizations from any liability or damages which may result from furnishing such information. I waive any right, under Public Act 397 of 1978, to receive written notice from this hospital or former employers that such information has been released. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the employer. I further understand that the policies, rules, regulations of employment, this application, anything said during the interview process, or any verbal offer of employment shall not be deemed to constitute the terms of an implied employment contract. I understand that employment with Marlette Regional Hospital is contingent upon proof of identity of verification of eligibility of employment in the United States, in accordance with the Immigration Reform Act of 1986. I have read and understand the above, and hereby certify that the facts I have provided in my employment application are true and complete. Submitting my application constitutes my signature and desire to apply for employment. Marlette Regional Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state, and local laws. Marlette Regional Hospital complies with applicable laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training.