Team Dobie Application

I certify that the information contained in this application is correct. I authorize the references listed above and designated former and/or current employer(s) to give you any and all information concerning my previous or current employment and any pertinent information that they may have, personal or otherwise.

I understand that I may be required to submit to a physical examination, which may include a drug test, prior to beginning employment and that I must satisfactorily pass such an examination to obtain employment.

I have read and fully understand the questions on this application for employment. I have completely, truthfully, and accurately answered each and every question to the best of my knowledge. I understand that all the inquiries on this application are subject to verification and authorize any schools that I have attended, licensing and certification boards and designated current and previous employers to release any requested information to the Ingham County Medical Care Facility (“facility”). I also specifically waive written notice from any and all former employers regarding their disclosure to the “facility” of any prior disciplinary action and waive any claim against the “facility” and current or former employers arising from such investigation or disclosure. I understand that any misrepresentation or falsification of the information I have supplied or failed to supply can result in a rejection of this application or, if I have been hired, an immediate dismissal at the sole discretion of the Ingham County Medical Care Facility.

I understand and agree that in the absence of an express written contract or agreement to the contrary, signed by an authorized executive of the Ingham County Medical Care Facility (“facility”) and by me or my authorized representative, any employment I accept shall be for an indefinite term and may be terminated at any time with or without cause either by me or at the will and sole discretion of the “facility” regardless of any contrary provisions in any other forms, manuals, handbooks or other documents. Similarly, such employment shall be at the wages, benefits, hours and conditions as the “facility” may determine and change from time to time, and I agree to abide by any rules, regulations, policies and procedures that may be established from time to time. I understand that no one, other than an authorized executive of the “facility”, has any authority to enter into an agreement with me contrary to the provisions of this paragraph and that any such agreement must be in writing and signed by such authorized executive or it shall not be effective.

I agree that any action or suit against the “facility”(employer) arising out of my employment or termination of employment, including but not limited to claims arising under State or Federal civil rights statues, must be brought within 180 days of the event giving rise to the claims to be forever barred. I waive any limitation periods to the contrary.

It is with full understanding and agreement with the provisions of this Certification that I will accept any employment offered to me.