Work History (Record U.S. Military Services as a position)
Personal References (Not a Relative)
I certify that the answers given by me to the forgoing questions and statements are true and correct. I agree that Mercer Health shall not be liable in any respect if my employment is terminated because of falsification of statements, answers, or omissions made by me in this questionnaire. I expressly authorize Mercer Health to check my employment references to determine my suitability for employment. I also authorize the companies, schools, or persons named to give any information regarding my employment, character, and qualifications. I hereby release said companies, schools or persons from liability for any damages for issuing this information.
I understand that if I am employed, it would be for an introductory period; that if, in the judgement of the institution, I prove unsatisfactory during this period, the employment may be terminated by the hospital without notice; and that after this introductory period, the employment may be terminated by either party upon notice to the other. I also understand that my employment at Mercer Health is contingent upon the satisfactory recommendations from former employers and references.