PLEASE READ CAREFULLY BEFORE SUBMITTING:
I understand that any information found on this form to be knowingly false or omitted may be cause for termination. I understand that a physical examination may be mandatory and that my employment may be dependent on the results of this examination. I understand that a 2-step Mantoux Test or documentation of TB Infection status is mandatory and must be submitted within 4 weeks of hire. Follow-up will be required if my TB infection status is positive. This test/documentation is a condition of hire and is at my expense.
I will provide Donwood Manor with a current Personal Request for Criminal Record Search at my expense within three weeks from date of hire. I give my permission to conduct reference checks in connection with my application for employment.
I understand that all information concerning residents, physicians, volunteers and other employees is to be held in the strictest confidence and that breach of Donwood Manor’s confidentiality policy may be grounds for dismissal.