Shriners Hospitals For Children Application For Employment (Page 4 of 4) in pdf

Please read, acknowledge and initial each of the following statements.

I authorize investigation of all statements contained in this application and any supporting documents. I authorize Shriners

Hospitals for Children to secure information about my education or experience from former employers, educational

institutions, government agencies, or other references I have provided, and for those parties to provide information

concerning my education or experience, and hereby release all parties from any liability arising from such investigation. I

understand that employment may be subject to an investigation of my consumer credit history and if such an investigation is

to be performed, I will be requested to authorize such investigation in separate documentation. _____Initial

I understand that if I am offered employment, I will, as a condition of such employment, be required to submit proof of my

identity and legal right to work in the United States of America. _____Initial

I understand that if I am offered employment, I will, as a condition of such employment, be required to submit proof that I am

18 years old or older. _____Initial

I understand that if my job requires me to drive in the course of my employment, I will be required to possess a current and

valid drivers license and maintain a good driving record. I specifically authorize investigation of my driving record with the DMV

by Shriners Hospitals for Children. _____Initial

I agree, if I am offered employment, to abide by all rules and regulations of Shriners Hospitals for Children. _____Initial

I agree that, if I am offered a position, it will be offered on condition that my employment shall be at will and for no definite

period, and that my employment may be terminated at any time with or without cause and with or without prior notice. I

understand that, except for the Chairman of the Board of Trustees of Shriners Hospitals for Children, no supervisor, manager

or Hospital Administrator may alter or amend the above conditions. Only the Chairman of the Board of Trustees has the

authority to enter into any agreement for employment for a specified period of time or to make any agreement contrary to the

foregoing, and then only in writing. _____Initial

I understand that if I am offered employment, I will, as a condition of such employment, be required to provide an appropriate

specimen to Shriners Hospitals for Children and consent to have the specimen tested for alcohol and/or drugs by a laboratory

chosen by Shriners Hospitals for Children. I authorize the release of the test results, positive or negative, to the management

of Shriners Hospitals for Children. _____Initial

I understand that any offer of employment made to me is contingent upon the successful completion of a company physical

examination and drug/alcohol test. _____Initial

I understand that if offered employment, I will be required to sign Shriners Hospitals for Children’s intellectual property

agreement. _____Initial

I have read, understand, acknowledge and agree to abide by all of the above statements.

I consent to all investigation authorizations herein above stated.

Date:

Signature:

Form 4029

Page 4

1/29/2016

Shriners Hospitals For Children Application For Employment Page 4