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Read and Sign (Read the Following Carefully Before Signing)

We are an Equal Opportunity Employer and do not discriminate on the basis of race, color, creed, sex, sexual orientation or preference, national origin, age, marital status, religion, status with regard to public assistance, status as a disability, or any other classification protected by Federal, state, or local law. The information below will be used only in the compilation of data for Affirmative Action reporting.

Completion of this data is voluntary and will not affect your opportunity for employment, or terms or conditions of employment, if hired. Identification can be declared at any time prior to, or if applicable, after hire.

I certify that the information provided on this application is true and complete. I agree that if there is any misrepresentation or omission concerning the information on this application, any offer of employment to me may be withdrawn, and if I have already been hired, my employment may be terminated.

I understand that any offer of employment by Winona Health is contingent upon (1) my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States, (2) successful completion of any pre-placement physical exam and/or drug/alcohol test that may be required by the employer, (3) satisfactory results on any criminal and/or other background check that may be conducted, and (4) if applicable, successful completion of any post-offer medical examination.

No promises concerning the nature or length of my employment have been made to me. If I am hired, I understand that I have the right to terminate my employment at any time, and for any reason. Unless I am covered by a collective bargaining agreement containing a contrary provision, I also understand that Winona Health has the right to terminate my employment at any time and for any reason. I understand that no one employed by the company has the authority to modify these conditions, except in a written documentation signed by the president and chief executive officer of Winona Health.

I authorize Winona Health and its representatives to make an investigation of my past employment and educational background. I authorize any past and present employers, and educational institution, to release information concerning my employment and educational background to Winona Health. I hereby release all persons, past and present employers, and educational institutions from any liability to me if they supply information to this employer as part of its investigation.

My typed name reflects that I have read, understood, and have agreed to these terms and conditions. Typing my name below shall have the same force and affect as my written signature


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