REFERENCES

List 4 people who are NOT related to you and who have definite knowledge of your qualifications and fitness for the position for which you are applying.


1.


Are You Related To Any Board Members Or The Hospital Director?

Do You Have Any Family Members Currently Employed With G.B.Cooley?

Do You Have Any Relatives Living At G.B.Cooley?

Have you ever worked for G.B.Cooley Hospital Service District?


PRE-EMPLOYMENT AUTHORIZATION AND CERTIFICATIONS

Do you agree that if you are employed by G.B.Cooley Hospital Service District, the employer shall thereafter at any time and from time to time have the right to require a medical examination by a licensed physician of your physical or mental condition to include (but be limited to) X-ray examination and laboratory tests and that it shall further be a condition of your employment that you be mentally and physically qualified (as determined by medical examination) to perform the assigned duties of your position?

By signing and submitting this application, the applicant acknowledges that his/her employment is conditioned on the results of testing or medical exams.


In an attempt to judge the effectiveness of our recruitment efforts, we ask that you provide the following OPTIONAL information. G.B.Cooley Hospital Service District is an Equal Opportunity Employer and this information will IN NO WAY be used in the decision to hire or promote.


Is accommodation required during the hiring process?

I have no medical condition that would prevent me from performing the essential functions of the job for which I have applied.