Authorization and Release - CHI Health, Nebraska (NE) - Southwest Iowa (IA)

Authorization and Release


In connection with this application for employment, I authorize any employer, educational institution, law enforcement organization, state and federal government agency, information service bureau, and other persons contacted to release information regarding my character, performance, qualifications, background and reasons for termination of past employment to Alegent Health or its agent and I release all parties involved in providing said information from any and all responsibility or liability resulting from such investigation.

I also authorize the release of my driving history, criminal records, credit history, and Consumer Investigative Report (“Report”) to Alegent Health. I understand the Report may contain information about my background, mode of living, character, and personal reputation. I understand Alegent Health may obtain a copy of the Report by contacting Hirease. I acknowledge that a facsimile or copy shall be as valid as the original. Prior to taking any adverse action based on the Report, Alegent Health will follow the process listed below as prescribed by the Fair Credit Reporting Act.

According to the Fair Credit Reporting Act, if any adverse decision is made with regard to application for employment, based entirely or in part on the information contained in a consumer report or investigative consumer report prepared by a consumer reporting agency, you are entitled to receive a copy of this report along with a Summary of Your Rights Under the FCRA.

BY CLICKING ON SUBMIT, I HEREBY ATTACH MY SIGNATURE TO THIS EMPLOYMENT APPLICATION AS EVIDENCE THAT I HAVE READ AND AGREE TO THE ABOVE.
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Alegent Health participates in E-Verify, a Federal Program that helps certify that employees are eligible to work in the United States. Please read the attached notice for important information regarding applying for work with Alegent Health.

E-Verify Notice: http://www.uscis.gov/portal/site/uscis

Several of the documents to be completed require your signature. In compliance with 15 USC 7001-06, you agree that the act of typing your first name and last name shall be considered your "signature" for purpose of executing such documents and you further acknowledge and agree that your Electronic Signature is legally valid and indicates your agreement and consent where indicated just as a physical signature would if the same documents were produced to you on paper copies.