List name, address and phone number of previous employers with current employer first.
Beloit Health System is an Equal Opportunity Employer and does not unlawfully discriminate in the recruitment or employment of its employees in the basis of race, color, ancestry, national origin, creed, sex, marital status, age, sexual orientation, physical or mental handicap, membership in a reserve component of state or national military forces, or arrest or conviction record. No question on this application is intended to secure information to be used for any unlawfully discriminatory purpose.
I certify that the statements in this application are true and complete. I understand that any misstatement or omission of fact shall be sufficient cause for denial of employment or summary dismissal at any time during my employment. I consent to investigation by Beloit Health System of all information supplied by me and all references and previous employers to secure additional information. I release from any and all liability all representatives of Beloit Health System for their acts performed in good faith in connection with evaluation of my application, credentials and qualifications.
I understand that Beloit Health System is a drug and smoke-free environment, and that any offer of employment is contingent upon the satisfactory completion of a physical examination which includes a drug screen and investigation of my work record and references. I understand that nothing contained in this employment application, granting of an interview, any policies, procedures, or handbooks prepared by Beloit Health System creates an employment contract between Beloit Health System and myself. I understand that if I am employed by Beloit Health System, my employment can be terminated by either the Hospital or me at will, with or without cause, and with or without notice, at any time. No one other than the president of Beloit Health System has authority to make any agreement for employment which varies from the terms specified in this application.
I agree to the terms and conditions outlined as stated above.