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Equal Opportunity Employer

We appreciate your interest in employment and want to inform you that we are an equal opportunity employer. In accordance with federal law, we request that you complete the self-identification form listed below. Your responses will be kept strictly confidential. Should you choose to decline to answer, your application will not be prejudiced in any way.

We must ensure that no applicant for employment or employee of the EEOC is denied equal opportunity because of race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors. These protections extend to all management practices and decisions, including recruitment and hiring practices, appraisal systems, promotions, training, and career development programs.

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Information Regarding Post Job Offer Screens

All applicants following an offer of a position with Franciscan Healthcare will be required to submit to a Post Job Offer Screen. This screen consists of a series of physical exercises that are in direct relationship to the physical demands of the position offered. The screening also consists of a Urine Test to screen for Drug/Alcohol Use.

Your Agreement indicates that you have been informed that these tests are a requirement of your acceptance of a position with Franciscan Healthcare and that if any part of this screening indicates that you are unable to perform the essential functions of the position offered, the offer of a position may be rescinded.

If under age 19, a Parental Drug Screen Consent for Minor Child Form will be required to be signed by a parent at the time of the Post Job Offer Screen.

Disclaimer

I hereby agree to a health screening, tuberculin screening, and laboratory studies (if needed) as a condition of commencing employment at Franciscan Healthcare, West Point, NE.

I understand that my commencing employment is contingent upon successfully completing the health screening.

I hereby permit Human Resources and Employee Health Services to use the information given in this health screening for the purpose of placing me in a position at Franciscan Healthcare.

In addition, I authorize Employee Health Services to release any information regarding my health or physical condition to my personal physician.

I certify the answers given in the preceding pages are full, complete, and true.

I agree that falsified information or significant omissions may disqualify me from consideration for employment and will be considered justification for dismissal if discovered at a later date.

I am aware of the existence of my health record. This is kept in Employee Health Services. This file includes (but not limited to) the Pre-placement Health Questionnaire, Immunization Records, Work Restrictions, and Injury/Illness Incident Reports.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities. I agree to cooperate in such investigation and release from all liability or responsibility all persons, companies, or corporations supplying such information.

I understand that I will be required to follow the personnel policies and rules of the institution and that infractions of said rules may lead to dismissal. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

I further understand that this institution follows the "fair employment practice code" and there is no discrimination in the hiring of individuals based on sex, race, religion, age, or physical or mental handicap unrelated to the ability to perform the work required.

I understand that if employed I will have an onboarding period of 90 days.

Upon my termination of employment, I authorize the release of reference information on my work.

I understand that this application is not a contract of employment and that if employed, I will be an employee at will.

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