Mayo Careers Application

Name
Address

Date Available to Start Work
Today
Can you do Shift / Weekend Work?
How did you hear about this position?

Are you at least 18 Years of age?
Have you ever been convicted of a crime?
Note: Conviction is not an automatic bar to employment.
Have you ever been convicted of abusing, neglecting, or mistreating individuals, or misappropriation of their property in a healthcare setting?
Do you have any relatives in our employ?
Have you ever been employed by Mayo Regional Hospital?
Starting with most recent employer




In making this application for employment, I authorize contact with any school or former employer and/or references to verify the information that I have provided on this application. I release those parties providing reference information from any and all liabilities or claims arising from the verification process.
 
I acknowledge that this is a condition of employment to annually receive the flu immunization and I agree that I will receive the flu immunization, or I will provide appropriate and timely documentation for medical contraindication or sincerely held religious beliefs.
 
I certify that answers and statements made by me in this application are true, complete, and accurate to the best of my knowledge and belief. I understand that any false statements, misrepresentation or omissions made by me orally or on this application, or any other accompanying or required documents in connection with my application, may be grounds for denial of employment or dismissal after employment, regardless of when and how discovered.
 
I understand any job offer by an Northern Light Health Affiliate is conditioned upon: (1) receipt of acceptable recommendations for reference; (2) proof of U.S. citizenship or appropriate visa or work permit; (3) successful completion of a pre-placement physical examination; (4) if it is a requirement for the affiliate you are applying with, you must submit to a substance abuse testing approved by the state of Maine, please request a copy at the Human Resources Office where you are applying.
 
I authorize an investigation, through whatever means deemed appropriate, of all statements contained in this application and all facts resulting from the investigation. I release from all liability all sources supplying such information. The Employer is authorized to use any information obtained from its investigations to determine my suitability for employment. I release the Employer and all Northern Light Health Affiliates from any liability in connection with such investigation.
 
I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.