I hereby certify that the facts set forth in this application and the items included on my resume are true and complete to the best of my knowledge and authorize Lakeview Healthcare Systems (LHS) to verify their accuracy. I consent to taking any physical examination, medical or drug test which may be required by LHS, now or in the future, in order to determine my ability to perform the essential functions of the job, and I authorize the release of the result of such examinations or testing to LHS. I further voluntarily give LHS the right to make a thorough investigation of my past employment activities, criminal record, driving record, check reference information and personal history that is job related. I agree to cooperate in such investigation and release from all liability or responsibility all persons, companies, and corporations supplying such information. I hereby release LHS from any and all liability of any kind and nature that at any time, could result from obtaining and having employment decisions based on such information. I agree to use protective clothing or devices as required by LHS and to comply with the safety rules.
If subsequently employed by LHS, I understand that falsified statements of any kind or omitted facts called for on this application shall be considered sufficient basis for termination. I also understand that if I am employed by LHS and subsequently am convicted of a crime (other than a minor motor vehicle offense) or found to be in violation of any Federal or State law, administrative rule or programmatic requirement that I must immediately notify LHS’ Manager of Human Resources, or designee.
I understand and acknowledge, that unless otherwise defined by applicable law, all employees in Wisconsin are regarded as “at will.” An “at will” employment relationship is one where the employee may resign at any time, for any reason with or without cause. In addition, the employer may also discharge the employee at any time with or without cause. It is further understood that there is no contract, expressed or implied, for continued employment.
I understand that LHS requires the successful completion of a Criminal Record Check, Driver’s Record Check, TB screen, drug screen and a pre-employment physical as a condition of employment.
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Today’s Date
