In compliance with applicable laws, this facility does not discriminate because of age, sex, race, color, religion, marital status, national origin, veteran status, or disability.
As a part of our normal procedure for processing applications, a routine inquiry may be made concerning information on an applicant’s work and educational history. In compliance with the Fair Credit Reporting Act, further information of the nature and scope of such inquiry, if one is made, is available to you upon written request. All employment should be covered below including jobs held while in school or in the military.
Record your present or last position first and list back in chronological order.
This space is provided for you to briefly summarize any additional qualifications you feel important in considering your application for employment:
I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for dismissal. I authorize an inquiry to be made on the information contained in this application, and authorize any individual contacted during this inquiry to give you any and all information concerning my previous employment and any pertinent information that may have, personal or otherwise, and release all parties from all liability for any damage that my result from furnishing same to you. I agree that Surgery Center at Pelham may obtain an investigative consumer report on me. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided.
If an employment relationship is established, I agree to conform to the rules and regulations of Surgery Center at Pelham and my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the Facility or myself. I also understand that any period of employment is not for a specific duration and understand that with the exception of the Administrator of Surgery Center at Pelham no facility representative has the authority to make any oral or written agreements which are contrary to the foregoing.
By checking the box below, I certify that I have read, understand and agree to the above.