Consent Agreement

Read the following agreement carefully. By submitting the application to Terre Haute Regional Hospital Human Resources you are giving your consent for the items listed below. If a completed application is not received we will not be able to process your request.

Information I provide about my background, skills and job interests will be supplied to Human Resources when they are searching for applicants. This information is confidential and will only be used for hiring purposes by authorized personnel. I may request that my application be withdrawn at any time so my information will no longer be available to Human Resources.

I certify that all the information I put into the application is complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts requested by the application may result in exclusion of my information from consideration by Human Resources or immediate discharge at any time during my employment if hired. I understand that employment may be contingent upon, but not limited to, receipts of satisfactory references, an employment drug screen, license verification, criminal history, motor vehicle driving records, and proof of identity and authorization to work in the United States.

Your permission to proceed:
I authorize and grant permission for Terre Haute Regional Hospital and/or its agents, including consumer reporting bureaus and other third parties, to verify any of this information. The types of information that may be checked include but are not limited to references, educational, credit or criminal history, professional licenses, traffic, military, and drug testing records. I grant permission for Terre Haute Regional Hospital to collect and provide Human Resources the additional information that will be requested during the job employment process including biographical information, skills, structured interviews, and other background information.

Pursuant to the requirements of the Fair Credit Reporting Act, I understand that a consumer report may be made in connection with my consideration for employment. If I am denied employment, either wholly or in part because of information contained in a consumer report, a disclosure will be made to me of the name and address of the consumer reporting agency making such report. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release said persons, schools, companies and law enforcement authorities from any liability or damage whatsoever for issuing this information.

In consideration of employment, I agree to conform to the rules and regulations of the employer that hires me, and I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the employer or myself. I understand that no representative of Terre Haute Regional Hospital has any authority to enter into any agreement for employment for any specified period, or to make any agreement contrary to the forgoing.

I understand that the use of illegal drugs is prohibited during employment. I understand that all job offers are contingent on result of a Drug Screening Test.