Licensed Practical Nurse (LPN)

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I also authorize South Davis Community Hospital to conduct an annual check of my criminal history, as authorized by Utah Law. I further agree to release all person, organization, (including, but not limited to South Davis Community Hospital) or government agencies from any damages of or resulting from furnishing such information. I understand that this information will only be disclosed to those persons conducting the investigation, and those persons involved in making the employment or promotion decision.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, an employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, i understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that i am required to abide by all rules and regulations of the employer.

SOUTH DAVIS COMMUNITY HOSPITAL INC. IS A "DRUG-FREE WORKPLACE". I UNDERSTAND AND AGREE THAT AS A CONDITION OF MY EMPLOYMENT I AM WILLING TO PARTICIPATE IN RANDOM AND/OR PERIODIC DRUG TESTING AS REQUESTED.