Education & Training
Select the highest grade/year completed:
Less than 6th grade
List any special skills or training:
List any professional certificates or licenses held past or present including CNA (give number, expiration date, state):
NURSING APPLICANTS ONLY
Have you had special training in:
I understand this application is not a contract of employment. In the event I become employed by Lakeside Health System (LHS) I understand my employment is at-will and is not for a specified or definite term and that I may be discharged or I may resign at any time for any reason, with or without cause.
I certify that all answers provided herein are true and complete to the best of my knowledge. I understand the provision of false or misleading information or the omission of information on this application or given during an interview process could result in the rejection of my application or my termination if I become employed.
LHS, and/or its authorized agents may investigate any or all information I have provided on my application and/or resume including criminal convictions, education, and employment experience information. Such verification may take the form of an investigative consumer report whereby information is obtained through personal interviews with those able to verify the information I have provided as well as my character and general reputation. I will sign a consent form authorizing such verification, and my authorization will be valid until such time as I inform LHS in writing.
By submitting this form I authorize all former schools, employers and other references to provide information and opinion to (LHS) relevant to my experience, character, etc. This includes dates of attendance, degrees earned, dates of employment, wages, reasons for leaving employment and any other information regarding my performance that may be requested by LHS. I release LHS and all parties providing information from any liability or claims for damages including libel, slander, and invasion of privacy that may result from the disclosure and use of this information.
I understand my employment at LHS is subject to verification of my proof of eligibility to work in the United States, the successful passing of a physical examination and drug test, the favorable result of a criminal background check and where applicable, confirmation of appropriate credentialing.
If employed, I understand I am required to abide by all rules and policies of Lakeside Health System.
My typed name below shall have the same force and effect as my written signature.