Employment Application

 

Employment Application
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Background Check through NETStudy 2.0

I have been informed that Appleton Area Health is required by the Minnesota Department of Human Services to conduct a background study on all individuals employed by Appleton Area Health. If I am found to have a disqualifying characteristic, AAH will be told that I am disqualified, but will not be told what the disqualifying reason is. If I wish to submit a request for reconsideration of a disqualification, I must do so within 15 days of receiving the notice of disqualification. If I do not request the reconsideration within the 15 days, or if the disqualification is not set aside after reconsideration, I may be discharged from my position.

I authorize Appleton Area Health to conduct a background check and obtain fingerprints as a part of this process.

Your privacy rights are outlined in a separate notice entitled, "Background Study Privacy Notice" (dated 07.05.2012). It is available from the agency who is initiating this study to you, or by calling 651.296.3971 (voice) or 651.282.6832 (TTY).

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Values of Appleton Area Health

 

Each employee is expected to follow...the values that make us SHINE!

Service - our actions speak louder than words

Honesty - demonstrated by what we say and do

Integrity - know and do what is right

Nurturing - trusted and compassionate care

Empowering - promote positivity and teamwork

I have read and understand the "Values That Make Us Shine." If employed at Appleton Area Health, I agree to comply with and practice the values as outlined. Non-compliance of any of these values will result in disciplinary action per AAH policies up to and including termination.

Understanding and Authorization

I understand and agree that any offer to employment is contingent on completing and passing a physical examination based on the physical demands of the job for which I am applying.

I authorize investigation of all statements contained in this application and understand that misinformation or omission of information not given on my employment application form and during the physical examination is sufficient cause for discharge, if I am employed.

I understand that nothing contained in this employment application or in the granting of an interview or in any policies, procedures or handbooks I might receive, is intended to create an employment contract between the company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing and signed by an authorized representative of the company. If an employment relationship is established, I understand that I have the right to terminate my employment at any time, for any reason and the company retains a similar right regarding the discontinuation of my employment.

I understand that a criminal background check will be performed, education credits and previous employment history will be verified prior to employment; signing this application is authorization to do so.

Your Signature

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