Start with the most recent school you attended, and then add any additional schools in reverse order.

The following items are for our records and are not necessarily a bar to employment/re-employment. Please answer all questions as completely as possible.

Include the last 7 years of employment, starting with the most recent employer first. Include any military service.

Please provide a minimum of two (2) professional references; none may be a relative.

I certify that all answers given by me are in turn, accurate, and complete. I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered. Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of SUMC to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to veterans and individuals with a disability or any other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation. If hired, I agree to abide by all of SUMC’s rules and regulations, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either SUMC or me, I further understand that no representation, whether oral or written by any authorized representative of SUMC, at any time, can constitute a contract of employment. I understand that SUMC shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

I agree that by typing in my name in the box below that I am signing this application electronically.