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Proof of Citizenship or immigration status will be required upon employment.
   


   


   

The New York State Human Rights Law prohibits discrimination in employment because of age.
   

Education

Name & Location of all High Schools, Vocational Schools, Business Schools, Colleges, and Related Military Courses attended.
   
(if not graduated, credit hours completed)
   
(if not graduated, credit hours completed)
   
(if not graduated, credit hours completed)
   


   

Professional License or Registration

If you have a Professional or Technical License, Registration, Certification, or Permit complete the following:
   
MM/DD/YYYY
MM/DD/YYYY
   

Employment

Give past employment record as completely as possible. Starting with your present or most recent employer, including summer employment. If space is insufficient; list on an additional page or attach resume. For any unemployed or self-employed periods, show dates and locations. All data must be completely filled in. DO NOT write "see resume."
   
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MM/DD/YYYY - MM/DD/YYYY
   
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MM/DD/YYYY - MM/DD/YYYY
   
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MM/DD/YYYY - MM/DD/YYYY
   
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MM/DD/YYYY - MM/DD/YYYY
   


   


   

Release: I hereby declare that all the above statements are true and correct to the best of my knowledge, and authorize Niagara Falls Memorial Medical Center and/or Schoellkopf Health Center to inquire into all matters contained in this application including my educational and work records, with the understanding that any misrepresentation or omissions made herein will be just and due cause for my discharge from employment. I understand that I may be rejected for employment and may be discharged for falsifying or misrepresenting any information contained in this employment application or during the interview process. I may be terminated regardless of when the falsification or misrepresentation is discovered. I release all organizations, schools, or persons providing information relevant to my employment qualifications from all liability for any ensuing damages. I understand that nothing contained in this application or in the granting of an interview is intended to create an employment contract of any kind. I also certify that I understand that if hired, my employment is at will and can be terminated by Niagara Falls Memorial Medical Center and/or Schoellkopf Health Center, or me at any time for any reason.

As part of Niagara Falls Memorial Medical Center/Schoellkopf Health Center's effort to provide a safe and healthy work environment free from alcohol and drug abuse, all applicants who are being considered for employment will be required to undergo a drug screening before an employment decision is made. A positive test result will make an applicant ineligible for employment. I understand that ineligibility for employment is neither defined nor time limited.

I agree to submit to a Post Job Offer Physical and I also realize that as an applicant I may be asked to provide a sample of my urine and/or blood and consent to such testing for drugs and alcohol. Satisfactory completion of the Post Job Offer Physical and any other Physical Examination (i.e. drug and alcohol tests) is required for employment.

Federal and State Laws prohibit discrimination in employment because of age, color, creed, handicap, marital status, national origin, race, sex, religion, disability or veteran status.

Niagara Falls Memorial Medical Center / Schoellkopf Health Center is an Equal Opportunity Employer