Application for Employment

​It is the policy of this company to provide equal employment opportunities to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, physical or mental handicap or veteran status.
    The facility and its surrounding property have been tobacco free since 2009.

    Position Applying for:

    PERSONAL INFORMATION
    Address:
    What is your preferred method of contact:
    I am a US Citizen or otherwise authorized to work in the United States on an unrestricted basis:

    EMPLOYMENT HISTORY

    Present or Most Recent Employer
    Prior Employer #1
    Prior Employer #2

    EDUCATION

    POSITION INFORMATION
    The careful and thoughtful completion of this application is an important step in our consideration of individuals for employment. Therefore, you must complete the entire application. Your application must also specify the position you are applying for. Please be advised that your application will be placed in our inactive file for 6 months from the date of application. (In order for you to keep your application current, it will be necessary for you to inform our personnel office in writing, prior to the 60-day period, that you wish to remain on the company's active applicant list.) The application provides information which enables us to determine whether an applicant has the interests, background, and experience to be given additional consideration for employment. At the appropriate time you will be required to establish your citizenship or, if not a citizen, your eligibility for employment. Please print in ink and use your own handwriting. Use space on the last page to clarify any responses or, if desired, tell us anything else about yourself you believe relevant.
     
    I hereby affirm that the information provided on this application is true and complete to the best of my knowledge. I also agree that any false information, representations, or omissions may disqualify me from further consideration for employment and may result in discipline or dismissal if discovered at a later date.
     
    Before I can begin work, and as a pre-condition of employment, I understand I must be able to verify, as required by federal law, that I am authorized to work in the United States. I understand that all applicants offered a position must document their authorization to work before the hiring process will be complete. If selected for hire, I understand it will be my responsibility to provide the Manistee County Medical Care Facility with documentation establishing my right to work. I understand these documents will be reviewed at the time a conditional offer of employment is made.
    I authorize a thorough investigation of my past employment and education, including discipline records, and agree to cooperate in such investigation. I release from all liability and responsibility all persons, corporations, and/or educational institutions requesting or supplying such information and waive my right to notice of such disclosure.
     
    I understand that part of the Manistee County Medical Care Facility screening process will include a search of criminal conviction history records to verify information provided by me during the application process. As a part of this investigation, I may be required to provide my date of birth, sex, and driver's license and state of issue. I understand that this information may be required later to facilitate this investigation. My signature below signifies that I understand and agree to authorize Manistee County Medical Care Facility to secure criminal conviction history from the appropriate law enforcement agency, should the facility determine it is necessary to do so.
     
    I understand that if I am granted an interview, I will be asked at the time if I can perform the essential functions of the job for which I am applying, with or without reasonable accommodation. I also understand that if I have a protected disability that affects my ability to do the job I seek, I may ask the Manistee County Medical Care Facility to attempt to make a reasonable accommodation for it. Under federal law, it is my responsibility to inform the Manistee County Medical Care Facility that an accommodation is needed. I understand I must make request for accommodation in writing to the Human Resources Department as soon as possible. Under state law, such a request must be made no later than 182 days after the date I know or reasonably should know that accommodation is needed.
     
    If hired, in consideration of my employment, I agree to abide by the rules and policies of the Manistee County Medical Care Facility. I understand that my employment with the Manistee County Medical Care Facility is for an indefinite term, and I am subject to termination at any time with or without notice, with or without proper discipline warning, and with or without cause.
    I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand than any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior education and employment history.

    Furthermore I understand that if I am hired that either the company or I can terminate my employment for any reason not prohibited by state or federal law.

    By entering my name below in the signature field I am certifying that this is my true and legal signature.