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. The applicant understands that neither this document nor any
offer of employment from the employer constitute an employment contract unless a specified document to that effect is executed by the employer and
employee in writing. 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.
Background Verification Disclosure
As part of the employment process, Ohio County Healthcare may obtain a Consumer Report and/or an Investigative Consumer Report. The Fair Credit
Reporting Act as amended by the Consumer Reporting Reform Act of 1996 requires that we advise you that for purposes of employment only, a Consumer
Report may be made which may include information about your character, general reputation, personal characteristics, or mode of living. Upon written
request, additional information as to the nature and scope of the report, if one is made, will be provided in the event the report contains information
regarding your character, general reputation, personal characteristics, or mode of living.
Authorization and Release
During the application process and at any time during any subsequent employment, I hereby authorize the selected background check company, on behalf of
Ohio County Healthcare, to procure a Consumer Report which I understand may include information regarding my character, general reputation, personal
characteristics, or mode of living. This report may be compiled with information from courts record repositories, departments of motor vehicles, past
or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and
any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of
the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation,
personal characteristics or mode of living.
I acknowledge I am responsible for complying with Ohio County Hospital Corporation’s compliance and organizational policies. I realize that, if
employed, I have a role in the overall effectiveness of the compliance program including reporting suspected compliance violations.