I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind whatsoever, I agree that my employer shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers or omissions made by me in this questionnaire. I authorize employers, companies, schools or persons named above to give any information regarding my employment, together with any information they may have regarding me whether or not it is in their records. I hereby release said employees, companies, schools or persons from all liability for any damage, both legal and otherwise, for issuing this information. I also understand as a conditional offer of employment I MUST UNDERGO A PHYSICAL EXAMINATION AND SUBMIT TO A DRUG TEST. I WAS PERSONALLY INFORMED OF THAT FACT IN MY FIRST INTERVIEW WITH A REPRESENTATIVE OF THE COMPANY. I HEREBY CONSENT TO A DRUG TEST AND RELEASE AND HOLD DAVIS COUNTY HOSPITAL HARMLESS FROM ANY AND ALL CLAIMS AND CAUSES OF ACTION THAT I HAVE OR MAY HAVE IN CONNECTION WITH THE CONDUCT OF THE DRUG TEST, THE ANALYSIS OF THE TEST SAMPLE, AND THE MAINTENANCE OF THE RESULTS OF THE TEST. In addition, if accepted for employment, I hereby agree to abide by the rules and policies of my employer. (Direct deposit is authorized as the required payroll procedure for employee wage payment.)
I understand that any offers of employment are contingent on successful completion of the post-offer exam and background checks.
Further, I understand that any employment is “at will” and not for a stated period of time and may be terminated with or without cause, at any time, at the option of either myself or my employer. In addition, should my employer be or become subject to the conditions of the Drug-Free Workplace Act of 1988, I agree to abide by such established policies as relates thereto. 11/09/2017
I Agree *
Signature & Date *