Application

I voluntarily authorize Hillsdale Hospital to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies, or corporations supplying such information.

I understand any offer of employment will be contingent upon the results of a pre-placement medical examination which will include screening for illicit substances. I also acknowledge that if I am in need of any reasonable accommodations during the hiring process or ultimately in order to perform the essential functions of the job for which I am applying, I will notify Hillsdale Hospital as soon as possible.

I understand that if I am hired by Hillsdale Hospital, my employment relationship is at-will, meaning that either Hillsdale Hospital or I may terminate the employment relationship at any time, with or without notice and with or without cause. I acknowledge that Hillsdale Hospital may alter my position, job responsibilities, shift and work schedule at its sole discretion. I also understand this provision supersedes any oral or written representations to the contrary, unless I have been provided a written agreement, signed by the President of Hillsdale Hospital that specifically states my employment is not at-will.

I certify that the information given by me in this employment application is true, accurate and complete. I understand that if I have given any false information on this application or if I have omitted any material facts, I may be disqualified from employment with Hillsdale Hospital, or, if hired, I may be discharged immediately upon discovery of such misrepresentations or omissions.

I understand that, according to Hillsdale Hospital policy which I have read and understand, following a conditional offer of employment, I am required to submit to a pre-placement urinalysis, blood testing, or other screening. I understand that the analysis will be conducted by a qualified testing laboratory. I also understand if I refuse to consent, this will be viewed as my withdrawal from consideration for employment.

The purpose of this analysis is to determine the absence or presence of illicitly controlled substances. I understand a documented chain of specimen custody will be followed to ensure the identity and integrity of my specimen throughout the collection and testing process.

If I am offered a position of employment by Hillsdale Hospital, I hereby consent to collection of a specimen of my urine an/or blood for purposes of performing a drug screening. Furthermore, I hereby release and hold harmless Hillsdale Hospital and its employees and agents from the request to furnish my specimens, the testing of my specimens, and the disclosure of the testing results.