(List present/most recent employer first)
Prior to any formal offer of employment, it may be necessary to contact your current employer for an employment reference.
(List references, i.e. supervisors, instructors, etc. No Relatives)
(200k file size limit) (Only PDF, MS Word, TXT files accepted)
This application shall remain active for 90 days. After 90 days, if you are still interested in employment at
Broadlawns Medical Center, you must fill out a new application.
I hereby certify that the information given by me in this application is true and correct to the best of my
knowledge. I understand and agree that any false information, misrepresentation or omission of facts in this
application and the application process may be justification for refusal to hire, or immediate termination
of employment without recourse. I further understand and agree that all information furnished in this
application and the application process may be verified by BMC. I further understand and agree BMC amy
complete a full reference and background screening of me.
I authorize all employers, schools, persons and organizations, having relevant information and knowledge
of my employment, work habits, character and any criminal or other relevant record, to provide it to
Broadlawns Medical Center or its duly authorized representative for its use in deciding whether or not to offer
me employment and specifically waive any required written notification. I hereby release such employers,
schools, persons, organizations and Broadlawns Medical Center from all liability for any claims or damage
which may result.
I further understand that nothing contained in this employment application or in the granting of an
interview is intended to create an employment contract between Broadlawns Medical Center and me for
either employment or for the providing of any benefit. If an employment relationship is established, I agree to
comply with the rules and regulations of Broadlawns Medical Center and further understand and agree that
my employment and compensation can be terminated at any time, with or without cause or notice, at the
option of either Broadlawns Medical Center or me.
Further, if offered a position with Broadlawns Medical Center, I also agree to submit to a medical history and
physical examination, which includes drug testing, provided by Broadlawns Medical Center and understand
that my appointment is conditional on satisfactorily passing the examination prior to being placed on the job.
I understand that I will be responsible for providing BMC proof of BMC Mandatory Vaccinations (i.e. COVID-19, Influenza, MMR) at my expense or have an approved accommodation on file prior to beginning my employment.
BMC seeks to provide a healthy, comfortable, and productive work and health care environment. In the
event I am hired as an employee of BMC, I acknowledge and agree to abide by the BMC's "Tobacco Free
Environment" Policy. I understand that smoking or any tobacco use is strictly prohibited anywhere on the
BMC campuses or vehicles.
IMMIGRATION REFORM AND CONTROL ACT OF 1986:
To comply with the Immigration Reform and Control Act of 1986, if you are hired, you will be required to
provide documents to establish your identity and your authorization to be employed in the United States.
Such documents will be required within the first three (3) business days following your hire, or upon your first
work day if your employment period will be less than three (3) days.
A PHOTOCOPY OF THIS ASSIGNMENT IS TO BE CONSIDERED AS VALID AS THE ORIGINAL.
In signing this form, I certify that I understand all the questions and statements in this application.
IMPORTANT: By printing your full name above you release and agree that your full printed name is an equivalent of and a replacement for your handwritten signature, and that you certify that you understand all the questions and statements in this form just as if you had signed this application.